Psychotherapy for  Adults and Couples

Cynthia Ropek, MA
545 Collyer Street Longmont,CO 80501 720-933-0661

PAYMENT INFORMATION

 

My fee per therapy hour (50 min) is $125. Should we agree that a longer session is needed (couples, family, emergency individual sessions), the fee is prorated accordingly to session duration.

Unless other arrangements have been made, you are responsible for full payment at the time of each session. Payment may be made by personal check, cash, or credit card.

 

I take limited insurances. Please refer to your provider health care list to confirm my participation with your insurance plan and talk with me in advance about your wish to use insurance. If you have out-of-network benefits, I will provide you with a statement to enable you to bill the insurance company for reimbursement.

 

 

NEW CLIENTS

 

Click on the links below to download the Intake and Disclosure Statement forms.

The Disclosure Statement is required by Colorado State Law. It gives you information about my qualifications, my practice guidelines, your rights, and confidentiality. Please fill both out and bring them with you to our first meeting.

 

                          For Individuals                                                For Couples

 

 

 

 

 

 

Individual Disclosure Statement

Couple Disclosure Statement

Couple Intake Form

Individual Intake Form