Getting Started

Fees

Please contact us at (863) 606-6001 or [email protected] for details. At Family Psychological Services of Lakeland, our goal is to provide a high level of service by well qualified and experienced psychologists and counselors. This is reflected in our fee.

Insurance

Depending on your current health insurance provider or employee benefit plan, it is possible for services to be covered in full or in part. Please contact your provider to verify how your plan compensates you for psychotherapy services.

Our office accepts most Blue Cross and Blue Shield (BCBS) and Aetna insurance plans.

What if my insurance doesn’t cover therapy?

That’s okay! If you would like to see us even though we are not on your insurance, we can provide specialized receipts (called “superbills”) that you can submit to your insurance provider. If the services are accepted by your insurance, they would then reimburse you at their out-of-network rate.

Payment

We accept cash, check and all major credit cards as forms of payment.

Cancellation Policy

If you are unable to attend a session, please make sure you cancel at least 48 hours beforehand. Otherwise, you may be charged a Late Cancellation Fee.

Forms

If you would like to fill out this information before your appointment, please click the links below.

New Patient Paperwork for Dr. Dumville

• Patient Services Agreement Signature Form
• Adult Questionnaire
• Parent Questionnaire
• Couples Questionnaire
• HIPAA Rules Fact Sheet
• HIPAA Signature Form
• Patient Information Sheet – Self Pay
• Patient Information Sheet – Insurance
• Patient Services Fact Sheet

New Patient Paperwork for Ms. Carmen Simth

• Patient Services Agreement Signature Form
• Adult Questionnaire
• Parent Questionnaire
• Couples Questionnaire
• HIPAA Rules Fact Sheet
• HIPAA Signature Form
• Patient Information Sheet – Self Pay
• Patient Information Sheet – Insurance
• Patient Services Fact Sheet

New Patient Paperwork for Ms. Elizabeth Wills

• Patient Services Agreement Signature Form
• Adult Questionnaire
• Parent Questionnaire
• Couples Questionnaire
• HIPAA Rules Fact Sheet
• HIPAA Signature Form
• Patient Information Sheet – Self Pay
• Patient Information Sheet – Insurance
• Patient Services Fact Sheet

Any Other Questions

Please contact us for any additional questions you may have. We look forward to hearing from you!