Fee for Service
I understand that I am responsible to pay my therapist’s rate of $150 dollars per session at the time that services are rendered. I understand that my therapist will only bill my insurance company if I have TriCare or MediCare. I also understand that I am responsible to pay any co-pay my insurance has set. In the event I am a member of The Mission Church in Vacaville, CA, I may be eligible to a sliding scale for payment.
24 Hour Cancellation Notice
I agree to give a one-day (24 hour) notice to cancel my scheduled appointment, If I cancel my appointment with less than a one day notice, I will be charged my regular fee. If I do not notify my therapist of my need to cancel and simply do not appear for my scheduled appointment, I will be held responsible for the fee and agree to pay for my missed session.
I understand that there is a $30-dollar service fee for all returned checks