Rates for service:

Dr. Braunstein is an out-of-network provider and therefore does not accept health insurance. However, you may seek reimbursement from your health insurance provider. Consult your health insurance company for details. Aetna’s website provides information about out-of-network reimbursement and forms, and Independence Blue Cross provides a claim form.  

Dr. Braunstein’s fee is $170 per hour. Free phone consultations are available. If you are unable to afford the full fee, Dr. Braunstein offers a sliding scale based on income.

Accepts personal checks, cash, or credit cards in person at the end of each session. She provides all clients with an invoice for each session.   

 

Forms (ONLINE):

NEW PATIENT FORM - CHILD/ADOLESCENT

NEW PATIENT FORM - ADULT

PSYCHOTHERAPIST-PATIENT SERVICES AGREEMENT

Consent/Agreement Form

E-MAIL and SMS CONSENT FORM

AUTHORIZATION FOR RELEASE OF INFORMATION

CREDIT CARD PRE-AUTHORIZATION FORM

Forms (PRINTABLE):

New Patient Intake Packet 

New Patient Intake Form - Adult

New Patient Intake Form - Child