Psychotherapy Visit

Pre-visit check-in for enhanced retainer patients

Step 1 of 3

Patient Information

Confirm your identity and retainer status.

Full Legal Name *

Date of Birth *

Phone Number *

Enhanced Retainer Status Acknowledgment

I confirm that I am an established patient on an active Enhanced yearly retainer and that this psychotherapy visit is requested under my Enhanced retainer *

Psychotherapy Session Frequency and Limits

I understand and agree that:

My Enhanced retainer includes up to four psychotherapy sessions per month (typically weekly), subject to clinical appropriateness and scheduling availability.
Psychotherapy sessions are separate from medication management visits.
Medication management visits remain a separate monthly visit and are typically 20 minutes.

I understand and agree *