In compliance with the No Surprise Act that went into effect January 1, 2022, I am required to notify all healthcare consumers of your Federal rights and protections against “surprise billing”.

This Act requires that I notify you of your federally protected rights to receive a notification when services are rendered by an out-of-network provider and provide options to receive care from an in-network provider if desired.

Additionally, I am required to provide you with a Good Faith Estimate of the cost of services for the tentative duration of treatment. It is difficult to determine the true length of treatment for mental health care, but below is my best estimate based on a year duration of treatment.

I have also provided a list of fees that may incur throughout your care at Healing with Seals that are in addition to direct counseling services. These fees may occur due to the following (not an exhaustive list):

Late cancellation/no show fee

Medical records request

Completion of documents (FMLA, disability, summary letters, etc)

Consultation (IEP meetings, coordination of care, etc)

Subpoena (request to testify)

Below are good faith estimates for services provided by Tori Seals, LPC, Owner of Healing with Seals.

Individual Therapy (weekly): $140

Good Faith Estimates:

3 months: $1,820

6 months:$3,640

9 months: $5,460

1 year: $7,280

Couples Counseling (weekly): $160

Good Faith Estimates:

3 months: $2,080

6 months: $4,160

9 months: $6,240

1 year: $8,320

Premarital Counseling (weekly): $150

Good Faith Estimates:

3 months: $1,950

6 months: $3,900

Family Therapy (weekly): $175

Good Faith Estimates:

3 months: $2,275

6 months: $4,550

9 months: $6,825

1 year: $9,100