Financial Fit Questionnaire & Financial Consent

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Financial Fit Questionnaire & Financial Consent

Ford Williams Family Therapy, LLC ("FWFT") strives to make therapy financially accessible to as many people as possible. This questionnaire will help you understand if FWFT is a good fit for you financially.

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* Indicates required question

Email *

Your email

Name (last name, first name) *

Your answer

Phone number *

Your answer

Please indicate how you want to pay for your therapy services. *

Private pay: I want to pay for therapy services out of pocket and maximize my privacy.

Health insurance + co-pay: I want my health insurance plan to help me pay for therapy services.

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