Forms, Fees and Insurance

Mount Vernon Counseling Center

All forms are fillable.

  1. Open the downloaded PDF in Adobe Acrobat Reader
  2. Complete the form
  3. Click on File > Save As PDF

Download

Children’s Yale-Brown OC Scale (CY-BOCS) Self-Report Symptom Checklist

Download

Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist

Download

Center for Epidemiological Studies Depression Scale for Children (CES-DC)

Download

YALE-BROWN OBSESSIVE COMPULSIVE SCALE (Y-BOCS)*

Download

THE COLUMBIA IMPAIRMENT SCALE (C.I.S.) PARENT VERSION

Download

Center for Epidemiological Studies Depression Scale for Children (CES­DC)

Download

Patient Health questionaire – (PHQ-9)

Download

PHQ-9: Modified for Teens

Download

NICHQ Vanderbilt Assessment Scales

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Screen for Child Anxiety Related Disorders (SCARED) – Child Version

Download

Screen for Child Anxiety Related Disorders (SCARED) – Parent Version

Fees & Insurance

Our fees range from $180 to $325 for an appointment depending on which professional you see and for how long.

  • All fees are due in full at the time of service. Mount Vernon Counseling Center does not accept reassignment of benefits from any insurance company and does not bill insurance companies directly. If you have insurance, you can apply for reimbursement back to you and as a service McLean Counseling Center offers patients assistance to submit claims to their insurance.

As for insurance, we are always “out-of-network,” meaning that we have no contracts with insurance companies and thus are not “preferred providers.” Nevertheless, our services are almost always reimbursable.

  • If you have Medicare or Medicaid please inform us immediately. We do not participate with these plans and patients seen at our center cannot submit our receipts to these companies for reimbursement.
  • If you would like to keep a credit card on file, you may do so; however, it is the patient’s responsibility to inform us of any change in credit card information such as expiration date, etc., to avoid declined charges. Any returned check fees are also the responsibility of the patient.

 

Cancelled Appointments

When we schedule an appointment for you, we set aside that block of time for you exclusively. It’s not like a typical doctor’s waiting room where if you don’t show up, there are people lined up waiting to take your place. To make our practice viable, we generally require 2 business days notice for a cancellation; otherwise, you will be charged for a missed appointment.

Get In Touch Below

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Contact Us

(571) 800-9909

admin@mountvernoncenter.com

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