Forms, Fees & Insurance

Online Forms

For new clients

The information you provide will help us to find the best fit for your needs. If you have a preference for a specific provider, you may indicate this but there is no guarantee of their availability. Someone should contact you within 1 – 2 business days after you submit a request.

For professionals

The Westwood Group is a mental health resource for physicians, attorneys, individual mental health treatment providers, and private and government agencies. Please see our services section to see a sampling of the type of services our provider offer.

Forms assistance

Form assistance is available! Please call our receptionist at 804-264-0966, option 1 if you have any questions on how to fill out any of these forms.

Please note that all information provided on our forms will be treated confidentially and in accordance with our privacy and HIPAA policies.

Payment of Fees

Payment of your portion of the fees is due at the time of service. This may be made in the form of a check, cash, or credit card.

There is a $75 charge for missed appointments or appointments cancelled less than 24 hours in advance unless a prior arrangement is made with your provider. This notice is needed to reschedule the appointment time with another client. This charge is not covered by insurance policies.

There is a $35 charge for all returned checks.

A service fee of up to 10% per month will be added to any bill that is 90 days past due. If referral to a collection agency is necessary, an additional charge of up to 50% of the balance will be added to cover the cost of collection and any court costs.

Using health insurance to cover fees

If you would like to use your health insurance, call the number on your insurance ID card, ask the member representative to give you the information listed below, and  write down the details of your mental health coverage before your first session and bring it with you.

Completing this form will help you:

  • confirm that your provider is covered by your insurance and complete pre-authorization of services if needed.
  • determine if there is an annual deductible amount to be met before co-pays can start
  • if you need to pay a copayment (fixed amount due at each session) or coinsurance (amount based on a certain percentage of the charge for each session).

Non-covered services

Services not covered by health insurance include sessions exceeding 60 minutes, court testimony, letter- and report-writing, phone calls lasting more than five minutes, and authorized contact with other professionals, including attorneys, teachers, physicians, and providers.

These services will be discussed with the client in advance, and are usually prorated on the time involved, based on an hourly rate set by your provider.

Evaluation and testing : The cost of psychological evaluation/testing varies with the tests administered and will be explained by the examiner prior to testing.

The Westwood Group’s therapy fees:

Psychotherapy sessions:

  • Intake evaluation – $200
  • Adult Individual session – $175
  • Individual for children and adolescents session – $175
  • Family or Marital Therapy session – $175

Nurse practitioner sessions:

  • Intake evaluation: Brantley Holmes, NP – $250
  • Follow-up session: Brantley Holmes, NP – $75/$125/$175

Psychiatry sessions:

  • Intake evaluation: Wendy Cohen, MD – $300
  • Follow-up session: Wendy Cohen, MD – $100/$150/$200


  • Please give us 48-hour notice if you need to cancel an appointment.
  • Copayments are expected at each session unless you work out other arrangements with your provider.

Good Faith Estimate

If you are not planning to use insurance, please read our Good Faith Estimate.