All forms are fillable.
- Open the downloaded PDF in Adobe Acrobat Reader
- Complete the form
- Click on File > Save As PDF
Initial Intake Form
Consent for Telemedicine Form
Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist
Center for Epidemiological Studies Depression Scale for Children (CES-DC)
YALE-BROWN OBSESSIVE COMPULSIVE SCALE (Y-BOCS)*
THE COLUMBIA IMPAIRMENT SCALE (C.I.S.) PARENT VERSION
Center for Epidemiological Studies Depression Scale for Children (CESDC)
Children’s Yale-Brown OC Scale (CY-BOCS) Self-Report Symptom Checklist
Patient Health questionnaire - (PHQ-9)
PHQ-9: Modified for Teens
NICHQ Vanderbilt Assessment Scales
Screen for Child Anxiety Related Disorders (SCARED) - Child Version
Screen for Child Anxiety Related Disorders (SCARED) - Parent Version
Fees & Insurance
Our fees range from $200 to $425 for an appointment depending on which professional you see and for how long.
All fees are due in full at the time of service. McLean Counseling Center does not accept reassignment of benefits from any insurance company and does not bill insurance companies directly. If you have insurance, you can apply for reimbursement back to you and as a service McLean Counseling Center offers patients assistance to submit claims to their insurance.
As for insurance are always “out-of-network,” meaning that we have no contracts with insurance companies and thus are not “preferred providers.” Nevertheless, our services are almost always reimbursable.
If you have Medicare or Medicaid, please inform us immediately. We do not participate with these plans and patients seen at our center cannot submit our receipts to these companies for reimbursement. If you have Tricare, McLean Counseling Center is not able to submit claims on your behalf, however, you are able to submit claims on your own for reimbursement.
All fees are due in full at the time of service. We accept all major credit cards and HSA. We will collect your credit card information before your first appointment and your card will be automatically charged after each appointment. Please note that it is the patient’s responsibility to inform us of any change in credit card information (such as expiration date, etc.), to avoid declined charges.
When we schedule an appointment for you, we set aside that block of time for you exclusively. It’s not like a typical doctor’s waiting room where if you don’t show up, there are people lined up waiting to take your place. To make our practice viable, we generally require 2 business days’ notice for a cancellation; otherwise, you will be charged for a missed appointment.