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Disclosure
Substance Abuse Evaluatio

 

Disclosure Statement for

 

 

 

SOLUTIONS

 

Patricia  Burbank 

 

MA LPC NCC CAC-R

 

915 Airport Rd.

 

Jackson, MI 49201

 

517-937-9321

 

Fax: 517-688-9874

 

 


 

 

 

Specializing in:  Addictions, Relationship Problems, Grief and Loss, Chronic Health Issues,

Women's Issues, Major Life Changes, and Spiritual Growth

 

 


 

 

My standard fees are as follows:

 

Assessment -$140.00

 

Individual session -$90.00

 

Family or couples session- $90.00

 

Group sessions- $55.00

 

A sliding scale is used for those without medical insurance and incomes below $70,000 annually.  Verification of income is required to access reduced rates.  Sliding scale could drop fees as low as $30.00 for Individual Sessions and $15.00 for Group Sessions.

 

 

 


 

 

  A treatment agreement will be presented for your signature and will include information related to confidentiality, release of information to third party payors, and fees agreed upon, as well as documentation that you have received this disclosure statement.

 

 


 

 

 

In the event you are dissatisfied with some aspect of your services provided and would like to make a formal complaint, you may do so by contacting

 

Michigan Department of Community Health

 

Complaint and Allegation Division

 

P.O. Box 30670, Lansing, MI 48909

 

517-373-9196

 
The information provided on this site is for educational or informational purposes only and should not be treated as medical or behavioral health care advice. The information is not intended to be used for medical diagnosis or treatment or as a substitute for consultation with a qualified health care provider. Please consult your health care provider if you have any questions or concerns about your health.