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Reason for care
Administrative
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Billing & Payment
Please note: Grey Space Therapy is a private pay mental health practice. We do not accept insurance directly. We are considered an out of network provider. Payment is due at the time of session. We accept cash, Zelle, all major credit cards, and debit cards, including Flex Spending and HSA cards. Do you have a PPO Insurance? PPO Clients: You may qualify for reimbursement. We are considered an “out-of-network” provider---which means payment is due at time of services. I can supplement an itemized bill ("superbill) that you may submit for reimbursed for out-of-network services. Please contact us for more details and your insurance provider prior to learn what options are available to you. No Insurance or Limited Insurance? We offer private pay options if you are uninsured or looking to NOT use your insurance benefits. Please contact us for more details. HMO Insurance? HMO plans only allow you to visit in-network providers, Please contact your health insurance to discuss options. We are not in-network with any HMOs. Prefer not to use your insurance? Please let us know if this is an option for you.
Client Preferences
For example: what you'd like to focus on, insurance or payment questions, etc.
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By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.