Register

Registration is only required if you do not have a username. Please check your spam & junk mail folders to ensure you have not already received an email with a username and password. If you already have a username log in here

Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

Patient Information

/ Middle Initial

( optional )
 

( MM-DD-YYYY )






( for Text Message Reminders )

Bill To Contact

/ Middle Initial







Log in Details

( If patient is a minor, the legal guardian must enter their email address below. )



Between 8 and 40 letters and numbers

Challenge Questions

( These will be used to retrieve your password. Answers must be between 4 and 30 characters, cannot contain any spaces. )




( If you feel you must write down your questions in order to remember them, make sure to keep it in a safe place. )

Terms and Policy

Scheduling and Payment Policies

FEE SCHEDULE: $350 for a 45-minute session

PAYMENT: You are responsible for full payment of all scheduled appointment and services provided by Dr. Katie S. Davis at the time of service. Other services include telephone conversations lasting longer than 15 minutes, consultation with teachers or other professionals (with your permission), preparation of records or treatment summaries, etc., and will be billed at the regular session rate. If you become involved in legal proceedings that require our participation, you will be expected to pay for our time and services at the regular session rate. 

We accept payment via credit card, cash, or check. WE PREFER VISA/MASTERCARD. For clients paying by cash or check, we require a credit card to keep on file. We respectfully request that you sign below to authorize Dr. Katie S. Davis to keep your signature on file and charge your credit card for the balance of charges not paid in full after 15 days past the date of billing. Outstanding balances of more than 15 days past the date of billing will accrue late fees at the rate of $100 per month. Returned checks are subject to a $100 processing fee.

You will be charged for sessions kept or canceled with less than one week's notice (see cancellation policy below).

CANCELLATION POLICY: We have a one-week cancellation policy. We charge for all sessions canceled with less than one week's notice. 

INSURANCE RECEIPTS: Dr. Katie S. Davis does not accept insurance. Your insurance company may reimburse you for certain services that we offer. It is your responsibility to contact your insurance company and find out if you can submit for reimbursement. We can furnish you with receipts you can submit to your insurance company after we receive payment for services. If sessions are being reimbursed, it is the family's responsibility to maintain coverage. We do not take responsibility for your coverage, nor is it our policy to obtain pre-approval for our services. If your insurance company requests additional paperwork such as treatment reports or pre-certification forms, there will be an additional fee for these services.

PROGRESS REPORTS AND PARENT CONSULTATION: We are happy to provide brief parent reports via email or telephone (15 minutes or less). In addition, parents are welcome to schedule a consultation session either weekly or as needed, billed at the regular session rate, to discuss their child's progress.

Thank you for allowing Dr. Katie S. Davis to work with your child in a manner that honors his or her unique learning style. At any point during our relationship, please do not hesitate to call with any questions or concerns.

( Type Full Name )
( Full Name )