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Services, Fees And Forms

My fee is $150 per hour. I usually see individuals and couples for one hour appointments weekly. Most couples I see for a minimum of 20 sessions.

I charge $150/hour for supervision/consultation but I do have a few sliding fee spots.

Business coaching is done on a one year contract either weekly or bi-weekly and my fee ranges from $300-500 per hour depending on the complexity of the situation. A one year contract is necessary for accountability since often the habits we are trying to change require focus, commitment and time.

Most of my clients pay each session through an app called IvyPay. If you pay at the time of the session, a super bill will be sent to you each month. I will bill insurance for a client, although my fee is the responsibility of the client. I accept Medicare.

I ask for 48 hour notice for cancellation so that I can fill the session, but if a client is ill then generally if we can reschedule in the same week there is no charge for the missed appointment.

I do save a few slots for clients who need a sliding scale fee. Please let me know if this is your need so we can work together to try to come up with something that works for both of us.

  1. Fill out the Patient Name and Payment Description fields on the right

  2. Click the Pay Now button

  3. When on the PayPal site, enter the payment discussed in the Item Price field and click Update

  4. Submit your payments using your PayPal account or any of the major credit cards listed

Patient Name
Payment Description


Intake Form

Consent to Release Information

Consent for Treatment

Right to Receive a Good Faith Estimate

    Good Faith Estimate for Jean's Services

These forms use Adobe Acrobat PDF Reader. Click the link below to download Acrobat if you do not have it already installed.

   Jean Shirkoff
   Certified EFT Therapist & Supervisor
   Phone: 503-887-3313
   Fax: 503-297-0885
   1942 NW Kearney St Suite 12
   Portland, OR 97209

  • Couples EFT Therapy.
  • Family Therapy.
  • Individual Psychotherapy.
  • Business/Executive Coaching.
  • Supervision, Consultation.


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