Private Pay Individual MH/SUD / Couples / Family Counseling

---

Please complete this form. Intake forms will be sent to your email to complete before your first session. Thank you for booking with us. 

For more information, contact us at (810) 922-7628 or email: info@beemariellc.com

I understand the Individual MH/SUD Therapy services offered by Bee Marie LLC will cost $125 per session. I understand the Couples Counseling / Family Counseling services offered by Bee Marie LLC will cost $150 per session. I understand that I am a private pay client of Bee Marie LLC, and that my Health Insurance is not being billed. I agree to complete all requested forms including client history, informed consent, receipt of privacy practices, receipt of cancellation policy, various screening tools and other information as requested. I must book my appointment on www.beemariellc.com for each individual / couples / family session. If I need to reschedule an appointment, fees paid in advance will be applied to the rescheduled service appointment. For more information, call/text or email your questions to 810.922.7628 or info@beemariellc.com. Please answer yes or no in the final box on the form.