Forms & Billing

Please bring a copy of your completed forms to your first appointment.

Dr. Waxman and her associates do not currently participate with any insurance plans. You will be provided with the paperwork you need to submit.  Many insurance plans allow you to see an out-of-network provider and will pay for a portion of their services.  You are responsible for payment in full at the time of your visit (Dr. Waxman accepts cash, checks or credit card).  If you have out-of-network benefits, your insurance company will reimburse you directly.  The rate of reimbursement varies, depending upon your specific insurance plan.


The cost of our services may be covered by insurance, although we are out-of-network providers so families need to confirm this with their insurance companies.

Therapy (50-60 minutes, depending on provider) $170.00-215.00
TOVA Attention Testing $305.00-$495.00
Psychoeducational Assessment $3,150

Forms Required for All Patients

Authorization to bill Insurance

Office Form

Privacy Notice


Adult Patient Forms

Adult Consent for Treatment

Adult Psychosocial Form

Child Patient Forms

Child Consent for Treatment

Child/Adolescent Psychosocial

Consent for Testing

Quotient ADHD Testing

Quotient Information Sheet

Quotient Consent