Client Information

Individual Counseling:

Print, complete and bring to your first session: 
1) the Registration Form and
2) the Credit Card Authorization Form.

We will sign the Agreement & Disclosure Form together when we meet; however, you might want to read it in advance.  

3) Agreement & Disclosure Form

I am required to inform my clients about my HIPAA Notice of Privacy Policy; it is provided below for your information only.

4) HIPPA Privacy Policy

Couples/Marriage Counseling:

Print, complete and bring to your first session:
1) the Registration Form (one per partner),
2) the Couples Questionnaire (one per partner) and
3) the Credit Card Authorization Form (one per couple).

We will sign the Agreement & Disclosure Form together when we meet; however, you might want to read it in advance.  

4) Agreement & Disclosure Form


I am required to inform my clients about my HIPAA Notice of Privacy Policy; it is provided below for your information only.

5) HIPPA Privacy Policy

Rates & Insurance:

At this time, I do not accept insurance. Some insurance companies provide reimbursement rates for out-of-network providers. You would need to contact your insurance company for more information. I can provide you the documentation required for submission to your insurance company.


My standard rate for psychotherapy is $125+tax per 50 min session. Reduced fee options are available.

My standard rate for Emotional Triggers Treatment is $200+tax per hour. Reduced fee options are available.

Additional discounts for ETT are offered to medical and mental health practitioners.

Please inquire for more information.

 

Want to make an appointment?
Contact me!

Mariposa Counseling Center, LLC

210 W. Las Cruces Ave
Las Cruces, NM 88005

575-201-3334 (NM) or 720-663-0445 (CO) 
catherine@mariposacounselingcenter.com

I am committed to your privacy. Please do not include confidential or private information regarding your health condition in this form. This form is for general questions or messages.

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