For your convenience, you may print the forms above and bring the completed forms with you at the time of your first appointment. We ask that you wait to sign them until you are in our office. If you prefer, we will provide you with these forms at the time of your first appointment, but you will need to arrive about 15 minutes early.

Summit Counseling provides experienced and qualified Contract Therapists for you.

Summit Counseling will accept and file insurance for Blue Cross Blue Shield, Blue Cross Blue Shield Federal, and AHS State Network clients only. The fee is fixed at $189.00 per 60 minute session. It is possible through BCBS Mississippi network that you would only pay a co-pay per office visit. Summit Counseling makes no assurance that your insurance will pay your claims and you are responsible for the $189.00 charge regardless of whether your insurance pays.

For all other insured clients we will gladly provide a Statement of Service and Form 1500 for you to file your own claim. These clients will pay according to the sliding scale based on total family income at each office visit.

For clients without insurance, fees are based on your total family income from all sources according to a sliding scale ranging from $75 to $189 per 50-minute session on an income range of under $40,999 to over $201,000. The front desk can tell you where your payment will fall in the scale.

Fees are due at the time of your session. Summit Counseling accepts cash, check, credit or debit card.

For First Baptist Jackson Members
Active and attending members of First Baptist Jackson will receive six sessions at no cost for sessions with Summit Staff Therapists.  If additional sessions are needed your therapist can assist you with available options.

If members wish to see a Contract Therapist, we ask you to contribute $50 to the fee that the Summit Counseling ministry pays the therapist, in order to help defray the cost to this ministry.