Forms and Payment Information for Katie Malone, M.A., LPCC, LMFT

When beginning therapy it is important to know your rights as a client and to understand the limitations of confidentiality. Below are the forms and documents to use when working with Katie. Feel free to take a look and learn more about the counseling experience.

Katie’s Forms

Katie’s Practice Policies, Billing Agreement and Informed Consent For Treatment Form
Katie’s Social Media and Electronic Communication Policy
Katie’s What to Expect in Counseling
Katie’s Client Information Form
Katie’s Child and Teen Intake Form
TheraThrive Privacy Policies (HIPAA)
TheraThrive Credit Card Form
Katie’s Release of Information Authorization Form

Payment Information

Katie’s specific payment information is described in the Practice Policies, Billing Agreement Informed Consent For Treatment Form (also above). Katie accepts payment by cash, check, American Express, Discover, Mastercard, Visa, and Paypal. Currently, Katie is not an in-network provider with any insurance companies. Instead she provides clients with a superbill (detailed statement) as an out-of-network provider. This superbill can then be submitted to your insurance company for a possible reimbursement.


*It is important to note that some insurance companies will not reimburse services, therefore it is up to you to contact your insurance provider prior to beginning therapy in order to be informed on if you will be reimbursed, and how much you will be reimbursed. If you pay for and receive services by Katie, and later learn that you will not be fully reimbursed for your session(s), we cannot provide you with a refund. Please contact us with any questions about payment options, or call Katie directly at 925-954-6229, ext. 2 #. We look forward to talking with you!