intake-adult word doc-1 pp.rtf (RTF — 510 KB)
Intake Paperwork ~ for your first session if you have access to a copier, you can easily copy the paperwork for your first session by just clicking here
and filling it out comfortably at home over a cup of tea, and bring it with you to your first appointment. Easy!
If you plan to use your insurance... you must also copy this insurance form and sign it twice in blocks #12 and #13 to authorize billing your insurance instead of you - please know it is your responsibility to know what if your deductible is met, if not, what it is, and if you have a copay:
Monica King MSW ACSW client agreement-1 pp.docx (DOCX — 18 KB)
You will also need this Consent To Treatment - Please initial each paragraph at the end to show you have understood the content and are in agreement.
In order for us to bill your insurance, you'll also need to provide a copy of a picture id like your license,
and a copy of both sides of your insurance card.
If you're a parent - Please know that I no longer see kids or teens, but thank you for your interest.
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** I offer an affordable sliding scale (see below) to meet the needs of the diverse community that I serve. My intention is to make therapy in Ann Arbor affordable and accessible to anyone who is drawn to my practice. I strongly believe that finances should not be a barrier to psychotherapy, and strive to practice that belief in my business practices as an Ann Arbor Counselor and Therapist.
My normal fees:
$140 for your Initial Intake session, and
$120 for a regular follow up (45-minute)
Individual session
. $140 for a follow up session (60 minute)
Fees are set during the initial phone consultation or meeting. If you have circumstances that make this Ann Arbor counseling unaffordable, the fee can be adjusted based on your financial ability as well as my practice’s needs. I have a suggested sliding scale below for reference for clients who need this.
Feel free to call me at to discuss fees.
You may also Pay for professional services here, once your fee has been established:
*$3 transaction fee is added for use of paypal
To use Paypal to make a Payment amount you determine click on the link.
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Sliding scale:
Suggested fee per 45 minute session for your Ann Arbor Therapy, based on your Yearly income.
36,000 - below ..................... $50
36,000-48,000 ..................... $65
48,000- 55,000 ..................... $90
above 55,000 - normal fees
I will negotiate my fee if you have insurance but prefer not to use it.
I will do what I can to make my fees affordable if you have special circumstances affecting your finances. Sometimes clients forgo using insurance because they prefer privacy.