I understand that Awakening Aspiration gives me an estimate of my insurance coverage (if insured ) and that it is also my responsibility to fully understand my insurance coverage.

I understand that I am responsible for my balance at each session including copay, co-insurance, and/or deductible amount. My card listed on file will be charged for the full balance owed for each session.

I agree to email communications from Awakening Aspiration and can opt out at anytime.

I understand by completing this form it does not guarantee an appointment, your appointment will only be confirmed after you have completed all intake documents in the client portal.