Tinnitus Consult Sessions with Kevin Hogan

For the first time in three years, you can schedule a private tinnitus consult session(s) with Kevin Hogan to get help with reducing the volume and distress from tinnitus. Complete the application you’ll find below. Click submit at the end of the form. You will be sent a confirmation e-mail letting you know that Kevin has personally received your application. Then, within the next 3 days Kevin will personally respond to your application.

[When applying for a session or a block, you can use this rule of thumb: If you’ve had tinnitus for less than one month simply ask for one session. If you’ve had tinnitus for 90 days or less, request 5 sessions. Over three months, request 10 sessions.]

Tinnitus consult options:

$750 for your initial session of 90 minutes. All subsequent sessions are 60 minutes long.
Five sessions subscribed to in one block $2500
Ten sessions subscribed to in one block $4500

Exceptions to fees for any of the above: none.

Teleconsulting for Tinnitus – Private Sessions with Kevin Hogan, Psy.D.

Note: After your application is accepted, you will be contacted via e-mail to schedule your tele-consult session(s). At that time you will be asked to pay for the sessions you’ve requested.

Name*
First Last
Email*
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Consulting Session Options*
Please submit my application with one of the three requested options (choose one):
- I am applying for one (1) initial session of Tinnitus Tele-Therapy - a private 90 minute session by telephone with Kevin Hogan. I agree to the terms of this consultation.
- I am applying for a block of five (5) sessions of Tinnitus Tele-therapy. The initial session will be 90-minutes, Subsequent sessions being 60-minutes. I agree to the terms of this consultation.
- I am applying for a block of ten (10) sessions of Tinnitus Tele-therapy. The initial session will be 90-minutes. Subsequent sessions are 60-minutes . I agree to the terms of this consultation.
Terms*
Terms: Session times as described above. Once your application is accepted, you will be contacted via e-mail to schedule your session(s). On the day of your session(s), you will be expected to call the private number you are given. Session fees are non-refundable, except as described in the terms below. A session may be re-scheduled one time per block. You will be expected to use a telephone with excellent sound quality.
- By checking this box, I am agreeing to these terms and conditions of my Tele-therapy with Kevin Hogan.
Your current condition (check all that apply):
- Pulsatile tinnitus Severe
- Pulsatile tinnitus Moderate
- Whole Tone tinnitus Severe
- Whole Tone tinnitus Moderate
- Other sounds Severe
- Other sounds Moderate
- Hyperacusis Severe
- Hyperacusis Moderate
Current Hearing: (Select One):*
- Perfect
- Near Perfect
- Good
- Fair
- Poor
- Deaf One Ear
- Deaf Both Ears
Have Cochlear Implant*
- Yes
- No
Currently Suffering from (Check all that apply):
- Depression Severe
- Depression Moderate
- Anxiety Severe
- Anxiety Moderate
- Panic Attacks Frequent
- Panic Attacks Irregular
Complex Personal Issues like divorce or recent death of loved one?*
- Yes
- No
How long have you had tinnitus? Describe.*
What was the circumstance of the onset of your tinnitus?*
Had you ever experienced tinnitus prior to onset?*
- Yes
- No
Please answer thoroughly:*
Why have you contacted me instead of one of the thousands of other people who might be able to be helpful for you?
Understandings:*
I understand that the local time for a teleconsult with Kevin Hogan could begin at almost any hour of the day or night. I understand that Kevin Hogan is not a Medical Doctor and cannot prescribe medication. I give my permission for Kevin Hogan to consult with my Medical Doctor on his own time if he feels it necessary. I give Kevin Hogan permission to consult with my Professional Licensed Therapist if he feels it necessary.

I understand that Kevin Hogan has limited time available for clients and at any moment may decide to cease taking clients and stop working with current clients. If this occurs, a prorated refund of session fees will be made. I understand that if Kevin Hogan determines he can't help me that a prorated refund of future session fees will be made. I will not ask Kevin Hogan to break any laws in an effort to help me improve.
- I have read the above and check this box as my understanding the above information.
Agreement for Consultation*
I do not hold Kevin Hogan responsible or liable in any way for actions I take in treating my tinnitus or results from consulting with him. I have the capacity, desire and interest to make my own decisions and will consider Kevin Hogan's strategy as options.
- I have read the above and check this box as my agreement to it
Recommendations:*
I understand Kevin Hogan will never recommend herbs, vitamins, or remedies.
- I have read the above and agree
Insurance:*
I understand Kevin Hogan does not accept medical insurance but if we enter into a session block that he will, at my request, fill out insurance paperwork for possible reimbursement, after the fact.
- I have read the above and agree
Contacting Other Parties*
I will not ask Kevin Hogan to contact my insurance company, Medical Doctor or any other therapist.
- I have read the above and agree
Scheduling*
I understand Kevin Hogan no longer regularly practices therapy and therefore am working around his business schedule.
- I have read the above and agree
Treatment Period:*
I understand that getting well from tinnitus takes time.
- I have read the above and agree
Non-Scheduled Calls:*
I understand Kevin does not ever take phone calls except at the scheduled time. Kevin does take emails to clarify questions from a previous session during the week as time permits.
- I have read the above and agree
Please add any special considerations about you that you want Kevin to know about. Kevin receives thousands of requests per year and can only agree to work with a very small percentage of those inquiring.
Payment Information*
Credit Card Number Expiration Date
*
Name as it appears on card cvv