1. Private Pay Teletherapy Agreement

I understand Big Sky Pediatric Therapy is accepting:




2. Private Pay Teletherapy Agreement

I will be responsible for paying for any services received. Big Sky Pediatric Therapy will not file a claim to my primary insurance company for services provided for the duration of this agreement.

Please note the following Private Pay charges for services and fees as of 1/1/2020:

  • Evaluation- $360 per evaluation
  • Therapy Session- $72.50 per 30 mins/session
  • Consultation Fee- $36.25 per 15 mins
  • Late Cancellation Fee- $30 per session (Less than 24 hours notice)
  • No Show Fee- $60 per week
  • Appointment Hold- $30 per week

***Big Sky is currently offering a 10% discount on our private pay rate for all teletherapy services***



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