Good Faith Estimate Notice for Self-Pay Clients

Effective Date: July 27, 2025

Your Rights as a Client

You have the right to receive a "Good Faith Estimate" explaining how much your occupational therapy services will cost.

- Health care providers must give you this estimate in writing at least 1 business day before your scheduled service, upon request or when you schedule a service.
- You may request a Good Faith Estimate before you schedule a service.

Estimate Includes

The total expected cost of therapy or coaching sessions (per session rate and frequency).
Any other related fees (such as paperwork preparation, consultation fees, etc., if applicable).

What If the Bill Is Higher?

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. You may contact the provider or file a complaint with the U.S. Department of Health and Human Services (HHS).

Contact

To request your Good Faith Estimate or for questions:

Email: softpowerfm@gmail.com
Phone: (415) 895-2122