This form is for established clients who are wanting to update their billing preference. Please complete all required fields of this BILLING UPDATE FORM and click submit when completed. Once received our office will contact you within 2 business days.
Email is not considered a secure medium and therefore, confidentiality cannot be assured. Please use discretion when sending information that is sensitive in nature.
A description of the two payment options Mindful Counseling offers, to include a list of the insurance companies our billing staff can bill, is located in the PAYMENT OPTIONS tab of our website, www.mindfulcounseling.org
If the client is not the policy holder, indicate the policy holder’s information: