Ona vs TherapyNotes (2026): Which Fits Your Therapy Practice?

TherapyNotes fits a therapy-only practice that wants the lowest monthly bill and a live phone line at 2am. Ona fits a practice that also answers phones, prescribes, bills insurance and may add other services, because the call, the note and the claim sit on one record in one system.

Quick answer:

• TherapyNotes wins on live phone support around the clock, price at a small headcount, free non-clinical staff seats, a large auto-scored instrument library, text and phone appointment reminders, and video sessions with up to 16 participants.
• Ona wins on one record from the first call to the paid claim, an AI receptionist and an ambient scribe inside the product, AI included in the base plan with no per-clinician fee, the insurance cycle in the same system, and room to grow past behavioral health.
• The honest trade: Ona human support is in-app chat and email from a primarily business-hours team. The 24/7 in Ona is the AI answering patient calls, not a person answering yours.

Prices below were read from each vendor's own live pricing page on September 17, 2026.

What each one actually is

TherapyNotes describes itself as practice management software for behavioral health that helps you securely manage records, book appointments, write notes and bill. Everything in it assumes a therapy or psychiatry workflow, and that focus is the product's strength.

Ona is an AI-native practice management platform: CRM, EHR and RCM on one record, described on its own homepage today as the platform that replaces your EHR, billing and patient tools. The range is stated plainly in the homepage FAQ: "Ona scales from solo clinics to enterprise systems." Behavioral health is one of nine specialties Ona serves, next to primary care, physical therapy, women's health, nutrition, integrative and functional medicine, naturopathic doctors and medspas. Every feature is available on every plan.

So the shape of the choice is not "big versus small". It is depth in one lane against one system that covers several.

The support question, answered straight

This is the clearest thing TherapyNotes has that Ona does not, so take it first.

TherapyNotes publishes live phone support 24 hours a day, 7 days a week, by phone and email, with a dedicated Spanish-language queue. Their support page states it in those words. If a Sunday-night billing question with a human on the line is part of how you sleep at night, that is a legitimate reason to choose TherapyNotes, and no amount of product coverage cancels it.

Ona support is in-app chat and email with a real specialist, screen-share when chat stalls, guided onboarding and workflow tuning at no extra cost, and a dedicated account manager for larger practices. Ona's own support FAQ says it plainly: Ona is primarily a business-hours team today, stays responsive outside those hours, and does not promise a 24/7 on-call rotation.

The word "24/7" appears on both sites and means two different things. At TherapyNotes it is a person answering your call. At Ona it is the AI receptionist answering your patients' calls, booking against real availability, routing anything urgent to a human and writing the transcript into the chart before the line disconnects. Useful, but not the same product. Decide which of the two you actually need at 2am.

What one subscription covers

TherapyNotes includes, on every plan: unlimited clients, appointments and notes, scheduling, a custom client portal, secure client and staff messaging, basic 1:1 telehealth, an auto-scored instrument library, free TherapySearch profiles, unlimited file storage, automatic updates, a mobile companion app, and free client data import from another EMR.

What TherapyNotes bills on top: TherapyFuel, its AI, at $40 per clinician per month; Premium Telehealth at $15 per clinician per month; ePrescribe at $65 per prescriber per month; electronic billing at 14 cents per electronic claim, ERA claim and eligibility request; appointment reminders at 14 cents per text or call, with email reminders free; payment processing at 3.1 percent plus 30 cents per transaction; MIPS reporting at $359 per clinician per year.

Ona includes, on every plan: automated charting against SOAP, DAP, BIRP, your own or freeform templates, the ambient scribe, conversational intake, scheduling with a hosted booking page, a leads pipeline, telehealth, versioned consents, billing and invoicing, the insurance and eligibility workflow, tasks, reports and the patient portal. The AI is not an add-on: Ona states AI features are included in the base plan at no extra cost. The eligibility checks, claims and ERAs themselves run on an Ona Clearing House plan, which cash-pay practices skip.

What Ona bills on top: the AI receptionist on published minute tiers, e-prescribing at $45 and EPCS at $25 per prescribing practitioner per month, Ona Clearing House plans, omnichannel messaging at $150 a month from three practitioners, and Calls at $25 a month for calling, transcription and recording inside Ona.

Two structural differences matter more than any single line item. First, the AI. TherapyFuel is per clinician per month; Ona's charting and scribe are in the seat price. Second, the phone. TherapyNotes has no product that answers your patients' calls; Ona does, and it books, confirms and charts.

What each one really costs

Take a group practice: two clinicians, one front-desk person, insurance-billing, both clinicians using AI to draft notes.

TherapyNotes: Group at $79 for the first clinician plus $50 for the second is $129. The front-desk person is free, since non-clinical staff are included. TherapyFuel for two clinicians adds $80. That is $209 a month, before transactions. At 250 claims, 250 ERA and 500 eligibility requests, the 14-cent fee adds $140, taking it to roughly $349.

Ona: two practitioner seats and one staff seat is $305, AI included. Omnichannel is free at two practitioners. Ona Clearing House Core at $149 covers 250 claims, 250 ERA and 500 eligibility checks with unlimited providers and payer enrollments. That is $454 a month, or about $409 on annual billing with the 10 percent discount. Add the AI receptionist at 400 minutes for $100 if you want the phone answered.

TherapyNotes is the cheaper subscription at that shape. Say it clearly, because it is true, and because the practices that will be happiest on Ona are the ones buying the extra coverage on purpose rather than by accident.

A second honest line item: controlled substances. Ona charges $45 for e-prescribing plus $25 for EPCS, so $70 per prescribing practitioner. TherapyNotes charges $65 per prescriber and states EPCS carries no additional fee. TherapyNotes is cheaper there.

Neither vendor charges a setup fee or requires a long-term contract. TherapyNotes offers a 30-day free trial; Ona offers 14 days with full access to every feature and no credit card.

Where TherapyNotes is the better buy

Be honest about the list, because a buyer who discovers it after signing is a buyer you should not have had.

Choose TherapyNotes if a live human on the phone at any hour is non-negotiable. Choose it if your headcount is small and the monthly number is the deciding factor, especially with free non-clinical staff seats. Choose it if you lean hard on a wide instrument library, because TherapyNotes ships dozens of auto-scored instruments and Ona ships two. Choose it if text and phone appointment reminders carry your no-show rate, because Ona sends booking confirmations by email and has no automated reminder cadences today. Choose it if couples or family sessions are routine, because Ona telehealth is 1:1 while TherapyNotes Premium Telehealth supports up to 16 participants. Choose it if a clinician-facing phone app matters, because Ona's workspace and patient portal are mobile-friendly web with no native app.

Where Ona is the better buy

Choose Ona when the admin load, not the clinical note, is what breaks your week.

The phone is the hole in your day. Ona answers it. Calls are picked up around the clock, booked against real availability with service duration and buffers honored, and written into the chart as transcript and structured intake. First-time callers land in the leads pipeline with the right person notified. TherapyNotes has no equivalent, and a therapy practice losing new clients to voicemail is losing them at the most expensive point.

You want AI without a per-seat AI bill. Automated charting and the ambient scribe are in the base plan. Record in the room or on a video visit, or upload MP3, M4A or WAV audio up to 100MB, get a diarised transcript and a drafted note against your template, review and sign. Nothing leaves the chart unsigned, and Ona states it never trains models on your recordings.

The insurance cycle should not live in a second tool. Eligibility, the claim built from the signed note, submission, the denial queue and the patient balance run in the same system, and Ona Clearing House plans run on Stedi with no separate account, contract or fee on your side. Cash-pay practices skip the plan entirely. Flat monthly volumes instead of per-transaction cents is easier to forecast at volume.

You are not going to stay therapy-only. This is the quiet one. Ona is a general ambulatory EHR. A practice that adds a prescriber, a dietitian or a primary-care clinician keeps one record, one booking page, one billing queue. A behavioral-health product means a second system the day you widen.

How the two compare

One axis: how much of a therapy practice's operating day one subscription covers without adding another vendor. It is not a quality ranking, and the cheapest row is not the top row. All figures read from each vendor's live pricing page on September 17, 2026.

Coverage rank	Platform	Included in the subscription	Billed on top	Human support	Published entry price
1	Ona	Charting and ambient scribe, intake, scheduling, leads, telehealth, consents, billing, eligibility and claims, tasks, reports, patient portal; messaging free at two practitioners or fewer	AI receptionist from $100 a month for 400 minutes; e-prescribing $45 and EPCS $25 per prescribing practitioner; clearing house plans from $69; omnichannel $150 from three practitioners; Calls $25	In-app chat and email, primarily business hours, same-day aim; account manager for larger practices	$130 per practitioner seat, $45 per staff seat, 10 percent off annually
2	TherapyNotes	Notes and records, scheduling, custom client portal, basic 1:1 telehealth, secure messaging, auto-scored instrument library, mobile app, unlimited storage, free data import	TherapyFuel AI $40 per clinician; Premium Telehealth $15 per clinician; ePrescribe $65 per prescriber; billing 14 cents per claim, ERA and eligibility request; reminders 14 cents per text or call; MIPS $359 a year per clinician	Live phone and email, 24 hours a day, 7 days a week, plus a Spanish-language queue	Solo $69; Group $79 first clinician plus $50 each additional, non-clinical staff free
3	SimplePractice	Scheduling, notes, client portal, telehealth and billing, scoped by tier	Note Taker $35; Care Aide $59 for the account owner and $49 per additional clinician; ePrescribe $49 a month plus an $89 one-time setup fee	Live customer support listed on the pricing page; no support hours published	Starter $49, Essential $79, Plus $99; additional practitioners from $74 each per month

Switching, either direction

Migration from any EHR into Ona is free, and the export and import is typically finished within one business day. Full cutover, with services mapped, the booking page live, templates rebuilt and the team trained, runs one to three weeks for smaller practices. TherapyNotes also imports client data from another EMR at no charge, with limitations that depend on what your current system exports.

The useful test is not a feature checklist. Run one real week in the trial: a new caller who has never been seen, a session recorded and signed, a claim built from that note and submitted, and a balance posted after adjudication. Whichever system does that chain without a second tab is the one that will still be right in a year.

Related reading: Ona Health review and Ona vs SimplePractice.

Frequently asked questions

Is Ona or TherapyNotes better for a therapy practice?

TherapyNotes is better if your practice is therapy only, you want the lowest monthly bill at a small headcount, and a live phone line at any hour matters. Ona is better if the phone, the chart and the insurance cycle should sit on one record, if you want the scribe and the rest of the AI without a per-clinician fee, or if you expect to add services beyond behavioral health.

Does Ona have 24/7 support like TherapyNotes?

No, and this is the clearest gap. TherapyNotes advertises live phone support 24 hours a day, 7 days a week. Ona human support is in-app chat and email from a primarily business-hours team that aims for a same-day answer on anything non-trivial, plus a dedicated account manager for larger practices. The 24/7 in Ona is the AI receptionist answering patient calls, not a person answering yours.

How much does Ona cost compared with TherapyNotes?

Ona is $130 per practitioner seat and $45 per staff seat per month, with 10 percent off on annual billing. TherapyNotes is $69 a month for a Solo user, or $79 for the first clinician and $50 for each additional clinician on Group, with non-clinical staff free. At two clinicians and one front-desk person TherapyNotes is the cheaper subscription. The gap narrows once you add AI for every clinician and per-transaction billing fees.

Does Ona score PHQ-9 and GAD-7 like TherapyNotes?

Ona ships PHQ-9 with the canonical 0 to 27 scoring, all five severity bands and a preconfigured flag on item 9, plus GAD-7 scored 0 to 21 with its standard bands, visible to clinicians only. Ona does not report across patients, and each result lives on its own form. TherapyNotes ships a much larger auto-scored instrument library, so if breadth of instruments is the deciding factor, TherapyNotes wins it.

Can Ona run couples or family video sessions?

Not today. Ona telehealth is 1:1, built on LiveKit, included on every plan, with a waiting room, one-click join from the consultation and screen sharing. TherapyNotes Premium Telehealth, at $15 per clinician per month, supports up to 16 participants with customizable backgrounds and high definition video. If multi-participant sessions are a regular part of your week, that is a real reason to stay with TherapyNotes.

How hard is it to switch from TherapyNotes to Ona?

Ona migrates you from any EHR at zero cost, with the export and import typically done within one business day. Full cutover, with services mapped, the booking page live, templates rebuilt and the team trained, takes one to three weeks for smaller practices. The 14-day free trial gives full access to every feature and needs no credit card, so you can run both systems in parallel before you commit.

Next step

Bring your hardest week and watch one caller travel all the way to a paid claim. Book a 15-minute demo, or start the 14-day free trial with full access to every feature and no credit card. If live phone support at any hour is the thing you cannot give up, say so on the call and we will tell you straight whether to stay where you are.