Practice

Good Faith Estimate Notice

The No Surprises Act notice that uninsured and self-pay clients are entitled to receive, written in plain language rather than statute. Fill in your fee, expected frequency, and projected annual total, then add it to your intake packet.

Pro Tool

Good Faith Estimate Notice

The No Surprises Act Good Faith Estimate notice for self-pay therapy clients, in plain language: their rights, your estimate, and the federal dispute process \u2014 ready to customize.

Plain-language explanation of the client's federal right
Estimate structure built for open-ended psychotherapy
Federal dispute-process language included
Client acknowledgment line for your records

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