Details & Contact
Fees, Forms, Contact & Location
Counseling in Newberg, OR

Details & Contact
Fees, Forms, Contact & Location
Counseling in Newberg, OR
Move your life and relationships closer to where you want them to be.
Teresa Heesacker
MA, CSD, LPC, LMFT, RPT
503-610-3499
1308 East First Street, Newberg, OR 97132
teresa@heesackercounseling.com
Heesacker Counseling
Ready to reach out? Please submit the secure form below.
Fees for Service
I provide a Good Faith Estimate for Health Care Services — this is a form in compliance with the Federal No Surprises Act that will indicate the estimated costs of treatment.
50-minute session…………$120.
80-minute session…………$180.
Sessions are weekly, every other week or monthly, depending on your needs.
Payment is made at the beginning of each session via cash, check, or debit/credit card. I am an out-of-network provider and will provide full-paying clients a superbill in order to seek reimbursement from their insurance companies or have the fee for service applied to their deductible.
There is no charge for sessions canceled 24 hours in advance. Phone calls and emails requiring over ten minutes will be billed at the hourly rate. Also, court appearances and the respective travel time to and from will be billed at the full hourly rate.
A sliding scale rate per session is offered and is dependent on client income. The sliding scale does not apply to court appearances and respective travel times. Please see the sliding scale document for a breakdown of service fees.
Forms
This link takes you to the sign-up as a new client on my client portal
Click here to login in for existing clients
Here are PDF versions of my forms:
- Payment Agreement Form
- Telemental Health Consent Form
- Professional Disclosure Statement
- Clients Rights & Responsibilities
- Notice of Privacy Practices
- Adult Client Interview
- Child-Youth Client Interview
- Family Relationship Development Interview
- Sliding Scale Fee Document
- Release of Confidential Information
- Video Consent Form
- Divorce Informed Consent Addendum