Eveline Smilack, MFA, LMFT
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TeleHEALTH

As of March 2020, online Telehealth services are available for treatment​ to maintain social distance and healthy practice of safety.

Rates

$200 per 50-minute session.  
Sliding scale services available on a limited basis.​

Payment

Checks, Cash, Credit Cards, and Apple Pay accepted at time of service, ​unless other prior arrangements have been made.​

Insurance

Out of Network provider. Statements are available and can be submitted for reimbursement. Please contact your insurance carrier for more information about your plan and coverage.

Appointments

​Please call (310) 869-1533 to schedule an initial free 15 minute phone consultation. 

CANcellations and ReschEduliing

If you need to reschedule or cancel an appointment, please do so at least 24 hours in advance to prevent a charge. Appointments are on a weekly basis, unless prior arrangements are made.​

FORMS

​Please complete and bring to our initial session:
  • Consent Form (Individual, Couple, Adolescent, Family)
  • Client Information Form
  • HIPAA Privacy Form
  • Credit Card Authorization Form​
  • Telehealth Consent Form
Couples: Please fill out a set of forms per person.
INDIVIDUAL CONSENT
File Size: 245 kb
File Type: pdf
Download File

CLIENT INFORMATION
File Size: 175 kb
File Type: pdf
Download File

HIPAA PRIVACY
File Size: 498 kb
File Type: pdf
Download File

CREDIT CARD AUTH
File Size: 138 kb
File Type: pdf
Download File

TELEHEALTH CONSENT
File Size: 188 kb
File Type: pdf
Download File

ADOLESCENT CONSENT
File Size: 249 kb
File Type: pdf
Download File

COUPLE CONSENT
File Size: 245 kb
File Type: pdf
Download File

FAMILY CONSENT
File Size: 245 kb
File Type: pdf
Download File


​​Starting the conversation is easier than you think. ​​
Schedule a Free Cosultation
Eveline Smilack, MFA, LMFT
​270 26th Street, Suite 205
Santa Monica, CA 90402
(310) 869-1533
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copyright  2016. Eveline Smlack, MFA, LMFT
All Rights Reseved
  • Home
  • ABOUT
    • MEET EVELINE
    • LEARN MORE
  • Services
  • Clients
  • EMDR
    • EMDR TREATMENT
    • EMDR CERTIFICATION
  • USC
  • Contact