Forms and Payment Options

Good Faith Estimate (GFE)

The No Surprises Act went into effect January 1, 2022 which requires us to provide a Good Faith Estimate of the costs of care.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services.
  • We will give you a Good Faith Estimate in writing at least 3 business days before your scheduled session, or within 1 day if you the schedule appointment is only a few days out. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
  • Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit or call

1. Informed Consent Form

2. Consent for Virtual Reality Therapy

Virtual Reality Exposure Therapy is extremely safe for the general population. A small percentage of the population may experience motion sickness (nausea, vomiting, ataxia, disorientation, eye strain and vertigo) due to “sensory cue incongruity”. That is due to differences between what they are perceiving in the virtual environment being different from what their body is experiencing. However, it should be noted that improvements in the lag time between the virtual images and head movements have reduced these side effects for many people.

There are some issues and disorders that are contraindicated for this type of procedure (see below for contraindications). Please read through the list of medical conditions on the CONSENT FORM. If you have been diagnosed with or believe you suffer from any of the listed medical conditions, mark the condition and notify Dr. Gurr.

3. Patient Intake Questionnaire

4. All New Patients Must Read HIPAA Compliance Form

5. Consent for Release of Confidential Information

Make payment for Therapy sessions and consultations by clicking on PayPal icon below:

Payment for Intake Session $275.00.

Payment for regular session- $250.00.

Payments through Paypal for other amounts can also be made here.