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Beginning January 1, 2022, federal law requires health care practitioners to provide current and potential clients who don’t have insurance or who are not using insurance a “Good Faith Estimate” (GFE) on the cost of treatment.
This new law is designed to provide transparency to clients regarding their expected medical expenses and to protect them from surprises when they receive their medical bills.
While it is not possible for a therapist to know, in advance, how many therapy sessions may be necessary or appropriate for a given person, this form provides an estimate of the cost of services provided.
I expect treatment will require continued weekly or bi-weekly sessions

continuing through the end of the year, at $350 per session for a total of 48 weeks, accounting for vacations and holidays for an estimated total of $16,800 (weekly sessions).


  • You have the right to receive a GFE for the total expected cost of any non-emergency healthcare services, including therapy services.

  • You can ask your healthcare provider, and any other provider you choose, for a GFE before you schedule a service.

  • You have the right to initiate the client–provider dispute resolution process if the charges you are actually billed substantially exceed the expected charges in this estimate (at least $400 more than your GFE).

  • You are entitled to disagree with any recommendations made to you concerning your treatment and you may discontinue treatment at any time.

  • Make sure to save a copy of your GFE or take a photo of it.

  • This estimate of costs is not a contract and does not obligate you to obtain clinical services from your provider.

  • For questions or more information about your right to a Good Faith Estimate, visit or call 1- 800-985-3059.

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