SLIDING SCALE APPLICATION

Sliding Scale Fee Application

The information you provide on this form will enable us to offer you an appropriate sliding scale fee and match you with an available therapist. This information will be seen by the practice owners and your individual therapist.

As with all protected health information, responses on this form will be kept confidential.

Sliding Scale FAQs

  • The first step is to contact our intake coordinator to learn more about the services offered at IMPACT. After talking with our intake coordinator about the services you are seeking, she will provide you with a link to the sliding scale application.

  • We use a sliding scale fee model based on income and resources because it allows us to address some of the systemic inequalities of class in our culture. We believe that financial resources and insurance coverage should not be the only determining factors in whether or not someone can access psychotherapy, testing or coaching. We have an abiding commitment to serving individuals who might not otherwise be able to afford these services.

  • Fees for psychotherapy range from $250 - $450 per session depending on therapist experience and expertise. The cost of a full psychoeducational, diagnostic, neuropsychological or personality assessment ranges from $4,000 - $8,000 depending on the time required, number of tests administered, and the complexity of the assessment process. Executive functioning coaching is typically $250 per session.

  • IMPACT offers a sliding scale fee for those who cannot afford the full fee. Our sliding scale model is designed to help those who have limited financial resources, do not have out of network coverage, or have high insurance deductibles. Our ability to offer a sliding scale fee is based on availability and financial need.

  • In order to be eligible for the sliding scale, you must complete the application, providing income information and an explanation of why you cannot pay the full fee. Although in most cases sliding scale is offered on an honor system, we may occasionally ask for you to verify your income (with a paystub or financial statement). A link to the application will be provided to you by our Intake Coordinator.

  • Sliding scale rates are approved for a duration of 12 months at a time. If at any point during that time your financial situation changes, please communicate this to your therapist and complete this form again. This includes changes in income, expenses, number of dependents, or insurance coverage.

  • Each provider in our group is able to accommodate 3-5 sliding scale clients at a time. The number of spots available varies over time as clients begin and conclude their work.

  • Time slots are based on therapist availability. We see clients weekday mornings, afternoons, and evenings, and some therapists have weekend availability.

  • Our approach to psychotherapy, testing, and coaching privileges social context as a key component of distress - including factors such as income inequality, racism, ethnocentrism, hetero-sexism, homophobia, transphobia, and religious persecution. We partner with clients to challenge institutional and social barriers that impede their social-emotional, professional, and personal development. Each of our clinicians provide pro bono asylum assessments for children and adults in partnership with Physicians for Human Rightsl. Offering a sliding scale fee, in accordance with clients’ ability to pay, is one small way that we seek to provide greater access to mental health services.