Forms and Fees

Forms & Fees

For All Patients

Intake Form

For Ketamine Patients

Ketamine Form

Fee Schedule

We are a very small practice. Insurance makes everyone suffer.

They may partially reimburse for Psychiatry and Psychology services.

Health Savings and Medical Savings accounts may be utilized.

  • Psychiatry Evaluation
  • Psychiatry Follow Up
  • Psychology Evaluation
  • Psychology Session
  • $444.44
  • $222.22
  • $277.77
  • $155.55

Patients should please:
Print the forms with your signatures and bring them to your
appointment. You can also ownload them, fill them out, save them, and then forward them to info@epiphanypsychservices.com

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