By proceeding, you indicate that you understand that you are directly responsible for the full session fee for any missed appointments unless you call to cancel/reschedule at least 24 hours before your scheduled appointment.
Various types of electronic communications are common in our society. Many individuals believe this is the preferred method of communication, whether their relationships are social or professional. Many of these modes of communication put privacy at risk. Therefore this can be inconsistent with the law and with the standards of the mental health profession. These policies are posted to assure the security and confidentiality of your treatment as well as to assure that it is consistent with ethics and the law.
By proceeding, you consent to the use of texting to schedule appointments with your counselor.
By proceeding you indicate that you understand that, should you choose to utilize the Initial Consultation service, you agree to pay the $75.00 and all future fees out-of-pocket.
By proceeding you indicate that you understand that payment is due at the beginning of each session unless other arrangements are made.
By proceeding you indicate that you understand that you are responsible to pay the full session fee at the time of service.
By proceeding, you indicate that you have read and understood the information regarding fees, and crisis services.
I authorize payment to be made to Christian Counselors.
Signed:_______________________ _______________________ Date_____________