USEFUL FORMS
NANCY WILSON, M.S., L.P.  
LICENSED PSYCHOLOGIST
COUNSELING FOR WELLNESS
Appointments
Schedule times by calling 952-250-9952. The appointment time is reserved especially for you and we require at least 24 hour cancellation notice. If you do not cancel 24 hours in
advance you may be charged for the time. If you miss an appointment, or cancel too late, you will be billed directly for the missed session as these charges cannot be submitted to
insurance companies. I schedule all appointments in advance, and offer various times throughout the week. The “clinical hour” is 50 minutes in duration (less if you arrive late).

Telephone Messages
You may reach me by calling my office number at (952)250-9952. I work part time out of my clinical office and keep other office hours at home. If you do not reach immediately you may
leave a message in my confidential voice mail. I check this several times a day and will return your call during my next available opportunity. My voice mail is not checked overnight,
however, or during times that would be specified on my voice message. In the case of an emergency, there are several emergency services available in the Twin Cities. You can also
call 911.

Emergencies
If this is a life or death issue, dial 911 or go to the hospital emergency room for evaluation. Do not leave a voice mail message for this type of message, especially if it is overnight. Below
I have listed local services that provide 24 hours a day crisis lines:

Dakota County                        (952) 891-7171
Hennepin County                (612) 374-3161
Crisis Connection                (612) 379-6363   (for all counties)

Fees
The fee for services is $100 an hour for counseling, and $160 an hour for Initial Intake appointments. If I am an in-network provider for your insurance, then I am contracted by them and I
will submit all insurance forms necessary. I will also contact them to clarify your insurance coverage after our initial appointment is scheduled. All co-pays are required to be paid at the
time of the appointment. Testing or consultation is made by arrangement.

Insurance
If you have a private insurance that I am not contracted with you might still be eligible for insurance reimbursement. While I will assist you in obtaining reimbursement, the ultimate
responsibility for your bill is yours. I encourage you to obtain as much information as you can about the mental health benefits that your health insurance company provides for you.

Ending Therapy
Most often, we plan for ending therapy work during the last few sessions. If for some reason we have not done that and you decide to stop, please let me know. I believe it is helpful to be
clear with each other about ending.
Useful Information: