Legal Compliance
Good Faith Estimate (GFE) Generator
Draft a compliant Good Faith Estimate for self-pay or uninsured clients. Capture practice details, expected services, and per-session fees, then print or save as PDF in one click.
Provider & Practice
This information appears on the estimate header.
Client & Diagnosis
Used to identify the recipient of the estimate.
Estimated Services
List each service the client is expected to receive, the frequency, and the per-session fee.
Estimate Validity & Notes
Set how long the estimate is valid and add any context the client should know about.
Ready to deliver the estimate?
Validate the form, then print or save as PDF for the client.
Document Preview
This is what the client will receive.
Good Faith Estimate
Practice Name
Provider Name
NPI:
Client
Name: —
Date of birth: —
Estimated services
| CPT | Description | Sessions | Frequency | Fee / session | Line total |
|---|---|---|---|---|---|
| Complete the form to see the line items. | |||||
| Estimated total | — | ||||
Your rights under the No Surprises Act
You have the right to receive a Good Faith Estimate explaining how much your care will cost. If you receive a bill that is at least $400 more than this estimate, you can dispute the bill.
Make sure to save a copy of this estimate. For questions or more information about your right to a Good Faith Estimate, visit cms.gov/nosurprises or call 1-800-985-3059.
Issued
2026-07-07
Valid through
October 7, 2026
Founder's Club offer
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Open toolWhat this Good Faith Estimate generator handles
The No Surprises Act requires providers to give self-pay and uninsured clients a Good Faith Estimate before treatment begins. This generator assembles the standard sections — provider information, client details, diagnosis, expected services, and totals — into a printable document you can hand to a client or attach to an intake email.
The estimate stays in your browser until you print or save it as a PDF. Nothing is uploaded, so you can use it for routine planning, new intakes, and renewal conversations without worrying about storing client-identifying information.
Use it for situations like
- A new self-pay intake who asks what therapy will cost over the next 12 weeks.
- A client moving from insurance to self-pay and needing a transparent cost outline.
- A renewal estimate when treatment is extending beyond the original scope.
- A paper trail for high-fee or extended-course cases where expectations need to be aligned up front.
FAQ
Questions therapists ask before using this calculator
When does a therapist need to give a client a Good Faith Estimate?
Under the No Surprises Act, any provider must give a Good Faith Estimate to uninsured or self-pay clients before care begins, or anytime the client asks for one. Estimates are typically delivered at scheduling or intake.
What information should a Good Faith Estimate include?
A complete estimate includes the provider and practice details, client name and date of birth, primary diagnosis, the expected services with CPT codes and frequency, and the per-session or per-item fees that add up to a total expected cost.
How long is a Good Faith Estimate valid?
Most solo practices keep Good Faith Estimates valid for 30 to 90 days from the issue date. The valid-through date should reflect how confident you are in the expected course of care and any planned rate changes.
Can the client dispute a bill that exceeds this estimate?
Yes. If the final bill is at least $400 higher than the estimate, the client can initiate a dispute resolution process. Keeping a signed copy of the estimate protects both the client and your practice.
Is this estimate a guarantee of final cost?
No. A Good Faith Estimate reflects the reasonably expected scope and frequency of services. If treatment plans change, you should issue an updated estimate so the client can make informed decisions.