Start A Self-Pay Request

For people and employers paying directly, not through insurance or Medicaid. Choose what you need below. You sign the Self-Pay Agreement and pay a deposit to hold your appointment: $250 for an evaluation, $100 for treatment. Our office then calls you within one business day. Not sure which to choose? Call us at 419.244.8624.

Is a court or agency paying? It sends the referral through Submit A Referral.

How it works:

1. Choose what you need and send your documents.
2. Sign the Self-Pay Agreement and pay the deposit.
3. Our office calls you within one business day.
We schedule your appointment once we receive your form and all required documents. We do not refund the deposit if you miss the appointment or cancel with less than 24 hours’ notice.

Self-Pay Evaluation

If you are paying for your own psychological evaluation, including an evaluation a court has ordered, start here.

Required Documents

Signed court order (judge or magistrate) specifying the requested evaluation and ordering CDTC as the provider
Indictments for all relevant charges
Police reports and/or prosecutor discovery materials
Your phone number and/or email, and the facility’s contact information if you are in custody

Parenting and child custody evaluations need more. The form lists what to send when you choose one.

Start Form

Self-Pay Treatment

If you are paying for your own counseling, therapy, medication management, or group treatment, including treatment a court or probation officer told you to get, start here.

Documents to Send, If They Apply

Your judgment entry or court order
Your PSI (Presentence Investigation) report, if you have it. If you don’t have a copy, your probation officer or attorney can give you one.
Other court or legal documents that explain your treatment requirements
Anything that shows you qualify for a specialized treatment program

Start Form

Board Reinstatement

If you are a licensed professional and your licensing board requires a psychological evaluation to reinstate your license, start here.

Start Form

Fitness for Duty (Employers)

If you are an employer referring an employee for a Fitness for Duty evaluation, start here. Your organization pays directly. About Fitness for Duty evaluations

Start Form

Important Notice:

Have your documents ready before you start. We schedule your appointment once we receive your form and all required documents. Your deposit holds your appointment. We do not refund it if you miss the appointment or cancel with less than 24 hours’ notice.

Self-Pay and Fitness for Duty Supplemental

This form is only for adding documents to a self-pay or Fitness for Duty request you already sent. Tell us the person’s name and which form you sent, so we can match it.

Submit Supplemental Documents

Questions about self-pay

What does the deposit cover?

The deposit holds your appointment: $250 for an evaluation, $100 for treatment. You pay it online when you sign the Self-Pay Agreement. For an evaluation, you pay the balance at your appointment. For treatment, you pay for each session at our front desk.

Can I get my deposit back?

If you need to reschedule, call us at least one day ahead and your deposit moves to the new date once. If CDTC cancels, your deposit moves to the new date. If you miss the appointment or cancel with less than 24 hours’ notice, you lose the deposit. We do not bill you anything more.

I have Medicaid or insurance. Can I use it?

This page is for people paying directly. If you have Medicaid or insurance, call us at 419.244.8624 and we will tell you what applies.

A court told me to get this, but I am paying. Which form do I use?

Use the self-pay form on this page and tell us about the court order on the form. If the court or an agency is paying, it sends the referral through Submit A Referral.

What happens after I submit?

You sign the Self-Pay Agreement and pay the deposit. Our office calls you within one business day. We schedule your appointment once we receive your form and all required documents. To send documents later, use the supplemental form on this page.