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ADJUSTED RATE ASSESSMENT:

How Our Rates Work

 

We Believe in Accessible Mental Health Care for All

We use income-based fees to ensure mental health support is accessible at every income level. This means your rate is personalized based on your financial situation and life circumstances. Most of our self-pay clients use adjusted rates. This form helps us understand your situation so we can determine what works for you.

Important notes:

We work hard to maintain an affordable model that mutually benefits clients and providers. While availability varies by provider and adjusted-rate spots may be limited, we’re committed to finding something that works. Completing this form doesn’t guarantee a specific rate or provider, but we’ll review your information carefully and connect you with the best available options based on current capacity.

HOW IT WORKS:

Submit this form
Share your financial circumstances to help us determine your rate options.

Complete anytime
You can fill this out before booking, after a consultation, or even after starting therapy—whatever works for you.

We review and respond
We’ll review your information and follow up as soon as we can with available rates and providers based on current openings and capacity.

Your rate begins
Your personalized rate begins once confirmed in writing.Note: Until confirmation, sessions are billed at standard rates.

Ongoing partnership

  • We review rates periodically or when circumstances change significantly. While rate adjustments are at our discretion, we’ll notify you before any changes take effect
  • You agree to update us if your circumstances change by checking in with your provider and resubmitting this form
  • We’ll reach out if we need updated information

OUR PROVIDER TEAM AND SERVICES:

We work with all types and levels mental health providers, including:

Associates (typically $60-160)
Licensed professionals gaining experience under clinical supervision

Independent Providers (typically $70-180)
Fully licensed clinicians practicing independently

Graduate Fellows (typically $30-60)
Advanced graduate students completing their clinical training under supervision

When it comes to benefits and outcomes, finding the right match tends to matter much more than credentials—it’s about finding the right person for you. Amazing support happens across all levels.

 

TYPES OF SUPPORT WE OFFER:

Depending on your provider’s licensure status and region, we offer:

Clinical services – Can include insurance billing, diagnoses, treatment documentation, and official letter.

General support services – Focused on improving your life and wellbeing, though not eligible for insurance or clinical documentation.Your provider will clarify which type of service they can offer based on your specific needs and location.

Personal Information

Name

Household & Income

(Include: wages, self-employment, unemployment, disability, benefits, child support, alimony, regular family support, other)

(Include: wages, self-employment, unemployment, disability, benefits, child support, alimony, regular family support, other)

Include: Partners/spouses, family members who use combined income.
Don't include: Housemates with completely separate finances.

Health Insurance

Do you currently have health insurance?
If you have insurance, does it cover mental health services?
Can you use your insurance for mental health services here?
Do you have an HSA (Health Savings Account) or FSA (Flexible Spending Account)?
Would you like information about submitting for out-of-network reimbursement?

Other Circumstances

Employment status:
Financial circumstances affecting your household:
When do you expect your financial situation to change?

Your Needs & Preferences



How often would you like to meet?
If we can't match your exact request, what's most important?
How long do you expect to receive support?
Provider flexibility
Your agreement: By submitting this form:
I understand that...
I will notify Seshio...
I understand that...
I will provide...

Clear Signature

I certify that the above financial information is correct to my knowledge.

What happens next?

Next steps Once we review your information, we’ll email you with personalized options and how to get started.
You’re helping us build something different Thank you for trusting us with this information. By participating in our income-based model, you’re part of making mental health care truly accessible. Together, we’re proving this can work.
Please share our practice with others who might benefit!
Questions? hello@seshio.org