Self-Pay Questionnaire

Individual Session Rates

Tier 1 - Reparations: 100 - 150

Tier 2 - Solidarity: 151 - 200

Tier 3 - Sustain: 201 - 250

Tier 4 - Full Cost: 251 - 309

Tier 5 - Redistribution: 310 - 360

I offer self-pay therapy on a sliding scale. In order to keep my practice sustainable, I have a limited number of spots at each tier.

Please fill out the form on this page to determine where you fall.

Please note: Scores provide general guidance. Individual circumstances not included in this form may be considered on a case-by-case basis.

Graphic and The Green Bottle Method by Alexis J. Cunningfolk