DBT Waitlist

FOR EVERYONE

Please review the following important information about the DBT Program. After you have read the information please check each box confirming your understanding of it. If there are items listed that you have questions about or disagree with please contact our office as you will only be added to the waiting list after accepting these policies.

After confirming all of the following statements, click the "Continue" button below. This will confirm your acceptance and take you to a page where you can enter your information for the waitlist. You may call our office or click here to send an email if you have any further questions. Thank you.

The DBT Program generally consists of 1 hour of individual therapy each week and a 2 hour skills training group each week. Attendance at both sessions each week is required. *
I acknowledge & agree

People participating in the DBT Program are asked to consent to one year of treatment, though this may be increased or decreased as clinically necessary.*
I acknowledge & agree

Participants are charged for each group and each individual session every week. The amount varies depending on insurance co-pay, deductible, co-insurance, etc. Clients are required to pay the expected portion each visit. Self pay rates, for those without insurance, can be found on the website under new client forms. *
I acknowledge & agree

We do not accept any Medicaid insurance. *
I acknowledge & agree

There is a $250 non-refundable fee that every client must pay when they begin the DBT Program. This fee is not covered by insurance and is a required programmatic fee that all DBT participants must pay in full by the start of DBT services, generally 3-4 sessions after the initial intake.*
I acknowledge & agree

The waitlist is managed on a first come first serve basis. Wait times vary greatly, but generally are at least 3 months and can run up to 9 months. People on the wait list can call the office to check on their placement on the list at any time.*
I acknowledge & agree

People who enroll in the DBT Program (after the initial intake assessment and commitment sessions are completed) are expected to terminate with their current individual therapist, if they have one, in order to fully participate in the program. Exceptions to this will be a clinical decision made between the individual and the therapists.*
I acknowledge & agree

FOR ADOLESCENTS (ages 13-17

In addition to the above 6 items, the following must be acknowledged:

A parent or legal guardian must accompany the adolescent to every skills training group.
I acknowledge & agree

The parent must pay a $25 self-pay fee for each group.
I acknowledge & agree

First Name *

Last Name *

Parent First Name (if client is a minor)

Parent Last Name (if client is a minor)

Email Address

Age *

Phone Number *

Insurance *

Referral Source *

Any special requests for a therapist *