New Patient Information

Your first appointment

Thank you for considering Kristie Jewitt, MS, LMFT, PLLC for your counseling needs. Your first 1-3 appointments will be focused on building a therapeutic relationship, assessment of symptoms and functioning, assessment of strengths, medical and psychological history, family history and your goals for therapy. You will be encouraged to discuss your reason for attending counseling in your own words and at your own pace. Your first appointment is approximately 55–60 minutes in length. Each subsequent session is 45 minutes in length. In order to get the most out of your first appointment, please read and complete the following 3 PDF forms and bring them to your first appointment. This will allow us plenty of time to get to know one another.

New Patient Information PDF Form
Consent to Treatment PDF Form
Notice of Privacy Practices PDF Form

The following is a release of information, stating that you grant me permission to communicate with your doctor (or whomever else you choose) in service of you. It is often helpful for me to communicate with the medical provider who referred you, or your primary care physician. If you would like me to do so, please complete this form and bring it with you to your first appointment.

Release of Information PDF Form

Insurance, Fees and Privacy Policy

I have chosen not to accept insurance and instead provide therapy on a fee-for-service basis. Typically insurance companies dictate the frequency and/or length of treatment while requiring information from your therapy sessions to authorize visits. Paying personally for your care gives you maximum privacy with the flexibility to plan your treatment around your individual goals.

If you have a health insurance policy and would like to use it to defer the cost of treatment, please familiarize yourself with your mental health benefits. Many insurance companies reimburse between 20-80% of each visit for an "out of network" provider, which I am. It will be your responsibility to complete and submit your insurance claim forms, so that you can then be reimbursed for the percentage that your insurance company covers. I am happy to provide you with whatever information (tax ID number, national provider number, etc) your insurance company requires on the claim form. Many require that I disclose your diagnosis. Please note, that you (not your insurance company) will be responsible for the therapy fee at the end of each visit. Therefore, it is important that you find out exactly what mental health services your particular policy covers. Questions to ask your insurance carrier:

1. Do I have out of network benefits? Do I need to meet a deductible to use them?
2. What percentage of each therapy visit is covered by my plan?
3. Where is the claim form that I need to submit to be reimbursed for each visit?
4. Do I need preauthorization to use these benefits? And if so, what is my preauthorization number?
5. How many sessions are authorized?

Additionally, I am happy to provide you with receipts for professional services that are required should you choose to submit this service to your Flexible Spending Account or Health Savings Account.

Therapy / Supervision Fees

Cash and checks are accepted forms of payment. There will be no charge for cancellations made 24 hours prior to appointment.

I am committed to maintaining your privacy throughout your therapy experience. As a mental health professional, I believe that privacy aids the therapeutic process and it is also required by law. For more information on Privacy Practices and how they relate to your personal health information please refer to the Privacy Practices form. If you have any questions about how I maintain your privacy do not hesitate to ask.

Phone Contact / Afterhours Coverage

During business hours, I am reachable by telephone. Please note, I do not typically answer the phone while I am in therapy sessions, thus it may be necessary to leave a voice mail message of which I will return before the end of the business day.

After business hours and on weekends an answering service is available in the event of a clinical emergency.

Medication and Therapy

As a licensed marriage and family therapist, I do not prescribe medication. If we decide, while working together, that medication would be helpful I am happy to collaborate with your primary care physician, or refer you to a community psychiatrist or psychiatric nurse practitioner. Or, if you already have a prescriber that you would like me to work with I will collaborate with them.

There is only one corner of the univers you can be certain of improving, and thats your own self. -Aldous Huxley