MindSource Center, LLC
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Relationship Development Intervention® Forms
(Click on the form name to download in PDF Format)

> RDA : What To Expect
> RDI Program Options
> Welcome Pre RDA & RDA Video Assignment
> What to Do While You Are Waiting
> Information on the RDI Assessment (RDA)-Office Version
> Information on the RDI Assessment (RDA)-Home Visit Version

> Video Authorization Release
> Health Information Release
> Declaratives
> My Resume

Counseling Forms
> Office Policy Statement
> Health Information Release


Individual psychotherapy, 50 minutes     $110
Initial diagnostic session, 55 minutes $130
RDI services, per hour $130
Extended psychotherapy session, 75 minutes $160
Late cancellation/missed appointment fee $40
Returned check fee $25



Most private health insurance plans are accepted; however, please check with your carrier to be certain of the provisions of your policy, including deductibles and co-pays, as you will be held responsible for any costs not covered by your plan. For your convenience, we will bill your medical insurance directly, unless you request otherwise. It is up to you to obtain any mental health pre-authorizations (if required by your plan) prior to your first visit. We accept MasterCard and Visa.


"Carrie has been very affirming in working with our family and has shared her wisdom and experience in a way that never feels judgmental." - (KB, attorney, WA)