Self-Pay & Administrative Fee Schedule
Psychiatric Services

Medical Weight Loss / GLP-1 Program

General Urgent Care Visits

Emotional Support Animal (ESA) Services
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FMLA / Medical Leave / Disability Forms

Other Psychiatric Administrative Letters & Forms

Administrative Services Policy
Administrative services, including forms and letters, are not covered by insurance and require dedicated clinical time outside of scheduled appointments. Documentation will only be completed when clinically appropriate and supported by the medical record. Submission of a request does not guarantee approval of documentation. Please allow 3–5 business days for completion. Expedited requests may be available for an additional fee, when feasible. Fees are subject to periodic review and adjustment based on time and complexity.