Restoration23
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    • Rhonda Jordan, LMT
    • Judy Holley, LPC
    • Trey Mickler, LPC
    • Sarah Zipfel, MA, LPC
    • Tess Wright, MEd, LPC
    • Jennifer Wallace, MA, APC
    • Leslie Cobb, MA
    • Christy Morrow
    • Mary Anna Brown, MA, APC
    • Sarah Brainard, LMSW
    • Haley Owens, LPC
    • Lori Johnson, LPC
    • Adriana Stanley, LPC
  • What We Do
    • Couples Therapy
    • Depression Treatment
    • Individual Treatment
    • Trauma Resolution
    • Anxiety Treatment
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        • No Surprises Act
      • FAQs
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No Surprises Act

STANDARD NOTICE

"Right to Receive a Good Faith Estimate of Expected Charges”
Under the No Surprises Act


You have the right to receive a “Good Faith Estimate”  explaining how much your medical care will cost

​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. This includes  related costs like medical tests, prescription drugs, equipment, and hospital fees.

Make sure your health care provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. 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 www.cms.gov/nosurprises or call Restoration 23 at 770-515-9023. 
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​3950 Cobb Pkwy, Suite 604, Acworth, GA 30101
(770) 515-9023
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Before Your First Visit

​Before your first session, You may fill out the necessary information online when you schedule your appointment or kindly take some time to print & fill out the form below as well as you can.
Client Information

Associations

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​"He Restores My Soul"
Psalm 23:3


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  • Home
  • Who we are
    • Rhonda Jordan, LMT
    • Judy Holley, LPC
    • Trey Mickler, LPC
    • Sarah Zipfel, MA, LPC
    • Tess Wright, MEd, LPC
    • Jennifer Wallace, MA, APC
    • Leslie Cobb, MA
    • Christy Morrow
    • Mary Anna Brown, MA, APC
    • Sarah Brainard, LMSW
    • Haley Owens, LPC
    • Lori Johnson, LPC
    • Adriana Stanley, LPC
  • What We Do
    • Couples Therapy
    • Depression Treatment
    • Individual Treatment
    • Trauma Resolution
    • Anxiety Treatment
    • Resources >
      • Books
      • Blog >
        • No Surprises Act
      • FAQs
    • Post-divorce Recovery
    • Family Therapy
    • Massage Therapy
  • Partners
    • Beacon Counseling
  • Contact Us