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Dr. Ruebel's Forms
 
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Here you will find links to forms that you will need to print out, complete, and bring with you to your first appointment with Dr. Ruebel.
 
PLEASE COMPLETE ALL FORMS BEFORE YOUR FIRST APPOINTMENT.

Parents - Click the BLUE LINK
Adults - Click the  GREEN LINK

Child/Adolescent paperwork

Adult paperwork

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Please note that I am required to provide access to a summary of how your Protected Health Information (PHI) will be handled under the HIPAA law. Please click the link below to review this statement:

Privacy statement

 
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  Dr. Ruebel's Fee Schedule 

Initial interview/Intake (55-60 minutes)             $160.00
Therapy session (40-50 minutes)                        $140.00

Psychological testing (per hour)                          $150.00                             

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Flexible payment options are available so please do not let insurance issues prevent you from seeking care. 

 

Dr. Ruebel accepts cash, checks, and credit/debit cards (Visa, MC, AMEX, and Discover).

 

You can also send your credit card information via email or fax. To do this please attach the Payment Option form to an email (you can download this form at the bottom of the page) or send a fax to (817) 431-5355.

 

If you prefer to mail in your credit card information, please click the link below to print the form to mail. 

 

 

Click here to download Payment Form