SociAbility Rates Group intake session One hour Pre-Group Sessions One hour Sessions (Prior to starting Groups) Group rates Per Semester Thursday/Saturday groups Summer 2017 (75-minute Session) Summer 2017 (60-minute Session) Monday groups Summer 2017 (75-minute Session) Summer 2017 (60-minute Session) $150 $150 $1,160 (8 sessions) $1,040 (8 sessions) $1,015 (7 sessions) $ 910 (7 sessions) Individual Therapy Rates Initial consultation One hour $300 Therapist Genevieve Thornton, Psy.D Noah Bach Bar-Tura, Psy.D Carly Walder, Psy.D., LLC Lorra Rudman, M.A., N.C.C., L.P.C. Sara LaMontagne, MA, MSW, LCSW Stacy McCarthy, J.D., L.P.C. Melissa Dore, B. A. $250 $180 $180* $150 $150 $150 $100** *Accepts Blue Cross/BCBS ** In-home behaviorial therapy Summer 2017 Payment Schedule We offer a fee schedule of two (2) payments payable each month for the summer. We will offer two options, you can provide a credit card to be kept on file and your payments will be processed on the first of each month June 1st and July 1st. Or we request that you provide two (2) checks to be deposited with us on each of the above dates. 60 minute classes are $1,040 per session = $520 for each payment 75 minute classes are $1,160 per session = $580 for each payment Sincerely, The SociAbility Team 899 Skokie Boulevard, Ste 204 Northbrook, IL 60062 www.sociabilitychicago.org Tel: (847) 559-3240 Dear Families: It is now time to sign up for summer groups! This year our summer session will begin June 17 th and continue through August 12th. (No groups July 1st through July 5th -see website for details). Please sign the enclosed paperwork and return to Karyn Lerner at [email protected] or call (847) 559-3240 by May 28th to guarantee your spot. These groups are highly desirable and we will start filling spots with new clients. Please do not risk losing your spot or having the group cancelled if you do not respond by this date. For new clients, sign-up requires an initial assessment and interview that has a fee of $150 to determine appropriate group placement. Additionally, we require four (4) therapeutic coaching sessions ($150 each) to assess your child’s strengths and challenges and to introduce them to the foundational skills that are practiced throughout the summer. It also helps the new group members prepare to join members who have already participated in our program. No groups will have more than 6-8 members. No more than 5 participants in groups for children 10 years and under. Waitlists will be implemented when groups are full. The cost for the eight (8) weeks session is $1,040 for 60 minute groups and $1,160 for the 75 minute session. Because of the July 4th weekend, there are only seven (7) sessions for the Monday groups. The cost for the Monday sessions is $1,015 for the Adult group and $910 for the Kidlings group. All groups are commitments for the entire semester. Our group success is based upon the consistent participation of each member a along with parent education and training to ensure generalization of skills. We work very hard to establish relationships amongst our group members and continuity and attendance is absolutely essential to each child’s progress in the group. We will not refund payments for missed sessions. Yes, I agree to sign up my child/adolescent for the summer groups at SociAbility. Please sign this form and return it to our office with full payment. Signed form and payment must be received to guarantee your spot. Child/Adolescent name: ________________________________________________ Parent/Guardian Signature: ___________________________________________ We are so excited to work with our families toward our 9th successful year of social thinking groups! 899 Skokie Boulevard, Ste 204 Northbrook, IL 60062 www.sociabilitychicago.org Tel: (847) 559-3240 Payment Authorization For your convenience, and to guarantee payment for services rendered, we require documentation of a major credit card. Otherwise, payment must be made at time of service. I authorize SociAbility, L.L.C. to keep my signature on file and to charge my credit card account listed below at time of service. I understand that this authorization is valid until I cancel the authorization through written notice to the health care provider. Card types: o Visa o Master Card o Credit o Debit o Discover Account number_____________________________________________ Expiration Date______________________ Security Code_______________________ Patient Name: ____________________________________________________ Card Member Name:_______________________________________________ Address: ________________________________________________________ City: _______________________________ Zip Code: ___________________ Telephone:_______________________________________________________ Card member signature:_______________________Date:____________________
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