Forms and Fees

Forms & Fees

For All Patients

Intake Form

For KAP Patients

KAP Form

Fee Schedule

We are a small practice and do not accept insurance except Highmark Blue.  PLEASE contact your insurance company for provider referrals if you would like to use your insurance.

Insurance MAY partially reimburse for Psychiatry and Psychology services.  PLEASE contact your insurance provider before your appointment.

Health Savings and Medical Savings accounts are frequently used for payment.

  • Psychiatry Evaluation
  • Psychiatry Follow Up
  • Psychology Evaluation
  • Psychology Session
  • $444.44
  • $222.22
  • $250.00
  • $200.00

Patients should please:
Print the forms with your signatures and bring them to your
appointment. You can also download them, fill them out, save them, and forward them to:  

 info@epiphanypsychservices.com

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