Forms and Fees

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My fee is $165 for a fifty minute session and $265 for an eighty minute session. I accept checks, credit cards, and cash with exact change.

I recommend an 80 minute session for work with couples and families.

Payment is due at the beginning of each session unless different arrangements have been made so that we can use the full session hour for counseling.

Sessions include: telephone calls, consults, requested reports and consultations with other professionals. These will be charged on a prorated basis.

Time spent in any way on legal proceedings is billed at three hundred fifty dollars ($350) per hour.

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Jessa Zimmerman


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Counseling Forms

Please click each form to print and fill out before your first session.

Individual Intake Form – one per person
Fee Agreement
Disclosure Statement
Notice of Privacy Practices

Online Counseling Forms

Forms should be mailed to Jessa Zimmerman, 1904 Third Ave, Suite 622, Seattle, WA 98101 prior to your first session.

Individual Intake Form – one per person
Notice of Privacy Practices
Online Therapy Fee Agreement
Online Therapy Disclosure Statement

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  • I do not take insurance directly.
  • Keep in mind that most insurance does not cover couples counseling (a “V code” diagnosis of relational distress).
  • If one of you has a medical diagnosis (anxiety or depression, for example) AND therapy is aimed at treating that condition and enhanced by working with the partner, insurance may cover the services. In that case, I can provide the receipt you would need for out of network reimbursement for our work together. Please ask me if you would like a receipt.
  • It is up to you to check with your insurance plan about possible reimbursement for out of network services.
  • If your company requests more information than is provided on the receipt, I will provide a brief summary of treatment and an explanation of why further treatment would be beneficial; I will not provide a treatment plan or therapy notes. You retain ultimate responsibility for payment for services if your insurance company decides that this documentation does not meet their requirements for coverage of your treatment.
Financial Hardship Spaces available unavailable at this time:
  • I maintain a limited number of appointments at a reduced rate for clients who meet the criteria for financial hardship.
  • If your household has an income less than $45,000 per year (adjusted upwards by $5000 per year per child in the household) AND you do not have insurance coverage that would reimburse you for counseling services, you may request the financial hardship rate ($90 for 50 minutes and $145 for 80 minutes).
  • These slots are given on a first come, first served basis and must be arranged in advance.
  • In order to serve the most clients possible, if you miss two appointments without prior arrangement, your financial hardship slot can be forfeited and given to someone else.
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