Common use of Appointments and Cancellations Clause in Contracts

Appointments and Cancellations. You are responsible for attending each appointment you agreed upon. You agree to adhere to the following policy: If you are prevented from keeping a scheduled appointment, you MUST notify me 24 hours in advance. If I do not receive a 24-hour advance notice, you will be responsible for paying the full fee for the session you missed, and that such fee cannot be billed to your insurance company. Psychotherapy is a uniquely personal service; therefore, consultations may be briefly interrupted. I will, from time to time, take time off for vacation, to attend seminars, and/or become ill. I will attempt to give you adequate notice in advance and will arrange coverage for any emergencies by a colleague. If I am unable to contact you directly due to circumstances out of my control, I will have a colleague contact you to cancel or reschedule an appointment. FEES: My private pay rate is $185 for the initial 90- minute assessment and $115 per 50- minute session. Couples/ Family therapy sessions are often 80 minutes at a rate of $165 per session. The group therapy rate is $45 per hour session. My practice is “fee for service” and that means that fees are due at the time of your appointment. Additional time will be charged in 15-minute increments. Payments are to be made immediately following each session or previous to the session if distance counseling. I accept cash, checks, debit cards and credit cards. If there is a returned check, the charge will be $35. If you indicate that a third party will be paying for any portion of your bill, an Authorization for Release of Confidential Information would need to be signed. This would allow me to contact that individual and share information regarding your billing/ payment arrangements. Please be aware that if your outstanding balance exceeds $95, I will not be able to schedule further appointments until the balance is paid. In the event that you miss your scheduled appointment time or cancel less than 24 hours, your credit card or debit card on file will be automatically charged. By signing this document, you agree to such cancellation and returned check fees. I reserve the right to terminate our counseling relationship if more than 2 sessions are missed without proper notification. I charge my hourly rate in quarter hours for phone calls over 10 minutes in length, email correspondence, reading assessments or evaluations, writing assessments or letters, and collaborating with necessary professionals (with your permission) for continuity of care. All costs for services outside of session will be billed to your credit/debit card on file.

Appointments and Cancellations. You are responsible for attending each appointment you agreed upon. You and agree to adhere to the following policy: If you are prevented from keeping a cannot keep the scheduled appointment, you MUST notify me our office to cancel or reschedule the appointment within 24 hours in advanceof the scheduled appointment time. If I do not receive you cancel or reschedule more than once, we may re-evaluate your needs, desires, and motivations for treatment at this time. Each insurance panel has a 24-hour advance noticedifferent policy on whether clinicians can charge for missed appointment/s. If applicable, you your will be responsible charged $75.00 for paying the full fee for the session you missed, and that such fee cannot be billed to your insurance companyeach appointment cancelled without sufficient notice. Psychotherapy is a uniquely personal service; therefore, consultations may be briefly interrupted. I will, from time to time, may periodically take time off for vacation, to attend seminars, and/or become ill. I Attempts will attempt be made to give you adequate notice in advance and will arrange coverage for any emergencies by a colleagueof these events. If I am unable to contact you directly due to circumstances out directly, or in the event of my controlan unexpected event such as illness, I a voicemail will have a colleague contact you be left indicating the need to cancel or reschedule an appointment. FEES: My private pay rate The fee for each 53+ minute therapy session is $185 for the initial 90- minute assessment and $115 per 50- minute session. Couples/ Family therapy sessions are often 80 minutes billed to your insurance at a rate of $165 per session175.00. The group therapy rate You may be responsible for all or part of that amount, depending on your deductible requirements. It is $45 per hour sessionyour responsibility to check your insurance benefits including deductible amount and copays. My practice Payment is “fee for service” and that means that fees are due at the time of your appointmentservice. Additional time Acceptable forms of payment are: exact-amount cash, check (insufficient-funds checks will be charged in 15-minute increments. Payments are to be made immediately following each session or previous to returned upon full payment of the session if distance counseling. I accept cash, checks, debit cards and credit cards. If there is a original amount plus $30 for any returned check), the charge will be $35. If you indicate that a third party will be paying for any portion of your bill, an Authorization for Release of Confidential Information would need to be signed. This would allow me to contact that individual and share information regarding your billing/ payment arrangements. Please be aware that if your outstanding balance exceeds $95, I will not be able to schedule further appointments until the balance is paidor credit/debit card. In the event that you miss your a scheduled appointment time is missed or cancel cancelled less than 24 hours, your credit card or debit card on file will be automatically chargedhours please refer to the “Appointments and Cancellations” policy above. By signing this document, you agree to such cancellation and returned check fees. I reserve The clinician reserves the right to terminate our the counseling relationship if more than 2 sessions are missed without proper notification. I charge my hourly rate The clinician charges $25.00 in quarter hours (15 min increments) for phone calls over 10 minutes in length, email correspondence, reading assessments or evaluations, writing assessments or letters, and collaborating with necessary professionals (with your permission) for continuity of care. All costs for services outside of session will be billed to your credit/debit via invoice or card on file. Fees are evaluated every 6-months for the business. Should there be a fee increase, you will be given a 60-day notice prior to it taking effect. In order to deliver quality care to you, and to all clients, it is important that I begin and end sessions on time. Late-shows for sessions will end at the normally scheduled time. TRIAL, COURT ORDERED APPEARANCES, LITIGATION: Rarely, but on occasion, a court will order a therapist to testify, be deposed, or appear in court for a matter relating to your treatment or case. In order to protect your confidentiality, I strongly suggest not involving your/your child’s therapist in the court. If I get called into court by you or your attorney, you will be billed separately for the time spent on any legal services at the rate of $225/hour. “Legal services” includes travel time, court time, preparing documents, etc.

Appointments and Cancellations. You are responsible for attending each appointment you agreed upon. You agree to adhere to the following policy: If you are prevented from keeping a scheduled appointment, you MUST notify me 24 48 hours in advanceadvance to cancel or reschedule your appointment. If I do not receive you cancel or reschedule more than once in a 2448-hour advance noticetime period, you we will be responsible discuss your need, desire and motivation for paying the full fee for the session you missed, and that such fee cannot be billed to your insurance companytreatment at this time. Psychotherapy is a uniquely personal service; therefore, consultations may be briefly interrupted. I will, from time to time, will periodically take time off for vacation, to attend seminars, and/or become ill. I will attempt to give you adequate notice in advance and will arrange coverage for any emergencies by a colleaguenotice. If I am unable to contact you directly due to circumstances out of my control, I will have a colleague contact you to cancel or reschedule an appointment. FEES: My private pay rate fee for each 45-minute session is $185 for the initial 90- minute assessment and $115 per 50- minute session195.00 or a discounted fee if worked out in advance. Couples/ Family therapy sessions are often 80 minutes at a rate of $165 per session. The group therapy rate Payment is $45 per hour session. My practice is “fee for service” and that means that fees are due at the time of your appointment. Additional time the session in the form of exact-amount cash, check (insufficient-funds checks will be charged in 15-minute increments. Payments are to be made immediately following each session returned upon full payment of the original amount plus $35.00 for any returned check), or previous to the session if distance counseling. I accept cash, checks, credit/debit cards and credit cardscard. If there is a returned check, the charge will be $35. If you indicate that a third party will be paying for any portion of your bill, an Authorization for Release of Confidential Information would need to be signed. This would allow me to contact that individual and share information regarding your billing/ payment arrangements. Please be aware that if your outstanding balance exceeds $95, I will not be able to schedule further appointments until the balance is paid. In the event that you miss your scheduled appointment time or cancel less than 24 48 hours, your credit card or debit card on file will be automatically charged. By signing this document, you agree please refer to such cancellation the “Appointments and returned check feesCancellations” policy above. I reserve the right to terminate our counseling relationship if more than 2 sessions are missed without proper notification. I charge my hourly rate in quarter hours for phone calls over 10 minutes in lengthany communication such as phone, text, email or postal mail correspondence, reading assessments or evaluations, writing assessments or letters, and collaborating with necessary professionals (with your permission) for continuity of care. All costs for services outside of session will be billed to your creditcredit card or required of you via check or cash. In-home/debit card On-site therapy services offer people comfort and flexibility. In-home/ On-site services are offered at a regular hourly rate. Cost for travel is based on filethe regular hourly rate and is determined by the time it takes for the me to travel from the office to your home or requested place of session and back. Time is configured by tracking and logging actual time or internet sites such as Google, Bing, Mapquest, etc. to determine travel time.

Appointments and Cancellations. You are responsible for attending each appointment you agreed upon. You agree to adhere to the following policy: If you are prevented from keeping a scheduled appointment, you MUST notify me 24 hours in advance. If I do not receive a 24-hour advance notice, you will be responsible for paying the full fee for the session you missed, and that such fee cannot be billed to your insurance company. Therefore, I require a credit card authorization form to be completed prior to the beginning of treatment and kept on file and updated annually or as needed. Psychotherapy is a uniquely personal service; therefore, consultations may be briefly interrupted. I will, from time to time, take time off for vacation, to attend seminars, and/or become ill. I will attempt to give you adequate notice in advance and will arrange coverage for any emergencies by a colleague. If I am unable to contact you directly due to circumstances out of my control, I will have a colleague contact you to cancel or reschedule an appointment. FEES: My private pay rate is $185 210 for the initial 90- minute assessment and $115 125 per 50- minute hour (55- minute) session. Couples/ Family therapy sessions are often 80 minutes range from 1 to 1.5 hours at a rate of $165 125 (55- minute) to $185 (85-minute) per session. The group therapy rate is $45 per hour sessionsession when available. My practice is “fee for service” and that means that fees are due at the time of your appointment. Additional time will be charged in 15-minute increments. Payments are to be made immediately following each session or previous to the session if distance counselingvirtual/ online counseling is being provided. I require a credit card authorization form to be kept on file and updated annually or as needed. I accept cash, checks, debit cards and credit cards. If there is a returned check, the charge will be $35. If you indicate that a third party will be paying for any portion of your bill, an Authorization for Release of Confidential Information would need to be signed. This would allow me to contact that individual and share information regarding your billing/ payment arrangements. Please be aware that if your outstanding balance exceeds $95, I will not be able to schedule further appointments until the balance is paid. In the event that you miss your scheduled appointment time or cancel less than 24 hours, your credit card or debit card on file will be automatically charged. By signing this document, you agree to such cancellation and returned check fees. I reserve the right to terminate our counseling relationship if more than 2 sessions are missed without proper notification. I charge my hourly rate in quarter hours ($31.25 per 15 minutes) for phone calls or email correspondence over 10 minutes in length, email correspondence, reading assessments or evaluations, writing assessments or letters, and collaborating intensive (more than brief consults/ periodic correspondence) collaboration with necessary professionals (with your permission) for continuity of care. All costs for services outside of session will be billed to your credit/debit card on file.

Appointments and Cancellations. You are responsible for attending each appointment you agreed upon. You agree to adhere to the following policy: If you are prevented from keeping a scheduled appointment, you MUST notify me 24 hours in advanceadvance to cancel or reschedule your appointment. If I do not receive you cancel or reschedule more than once in a 24-hour advance noticetime period, we will discuss your need, desire and motivation for treatment at this time. Each insurance panel has a different policy on whether you will be responsible for paying the full fee for the session you missed, and that such fee can or cannot be billed to charge a client for missed appointment. Check your insurance companyprovider’s policies regarding cancellations and/or no shows. Psychotherapy is a uniquely personal service; therefore, consultations may be briefly interrupted. I will, from time to time, will periodically take time off for vacation, to attend seminars, and/or become ill. I will attempt to give you adequate notice in advance and will arrange coverage for any emergencies by a colleaguenotice. If I am unable to contact you directly due to circumstances out of my control, I will have a colleague contact you to cancel or reschedule an appointment. FEES: My private pay rate fee for each 50-minute session is $185 for the initial 90- minute assessment and $115 per 50- minute session200. Couples/ Family therapy sessions are often 80 minutes at a rate of $165 per session. The group therapy rate Payment is $45 per hour session. My practice is “fee for service” and that means that fees are due at the time of your appointment. Additional time the session in the form of exact-amount cash, check (insufficient-funds checks will be returned upon full payment of the original amount plus amount charged in 15-minute increments. Payments are to be made immediately following each session or previous to the session if distance counseling. I accept cash, checks, debit cards and credit cards. If there is a by bank for any returned check), the charge will be $35. If you indicate that a third party will be paying for any portion of your bill, an Authorization for Release of Confidential Information would need to be signed. This would allow me to contact that individual and share information regarding your billing/ payment arrangements. Please be aware that if your outstanding balance exceeds $95, I will not be able to schedule further appointments until the balance is paidor credit/debit card. In the event that you miss your scheduled appointment time or cancel less than 24 hours, your credit card or debit card on file will be automatically charged. By signing this document, you agree please refer to such cancellation the “Appointments and returned check feesCancellations” policy above. I reserve the right to terminate our counseling relationship if more than 2 sessions are missed without proper notification. I charge my hourly rate in quarter hours for phone calls over 10 minutes in length, email correspondence, reading assessments or evaluations, writing assessments or letters, and collaborating with necessary professionals (with your permission) for continuity of care. All costs for services outside of session will be billed on the day service has taken place using the credit card information on file. Clients will be notified prior to such services taking place. In-home/On-site therapy services offer people comfort and flexibility. In-home/ On-site services are offered at a regular hourly rate. Cost for travel is based on the regularly hourly rate and is determined by the time it takes for the me to travel from the office to your credit/debit card on filehome or requested place of session and back. Time is configured by tracking and logging actual time or internet sites such as Google, Bing, Mapquest, etc. to determine travel time.

Appointments and Cancellations. You are responsible for attending each appointment you agreed upon. You agree to adhere to the following policy: If you are prevented from keeping a scheduled appointment, you MUST notify me 24 hours in advance. If I do not receive a 24-hour advance notice, you will be responsible for paying the full fee for the session you missed, and that such fee cannot be billed to your insurance company. Psychotherapy is a uniquely personal service; therefore, consultations may be briefly interrupted. I will, from time to time, take time off for vacation, to attend seminars, and/or become ill. I will attempt to give you adequate notice in advance and will arrange coverage for any emergencies by a colleague. If I am unable to contact you directly due to circumstances out of my control, I will have a colleague contact you to cancel or reschedule an appointment. FEES: My private pay rate fee for each session is $185 for the initial 90- minute assessment and $115 per 50- minute session200.00. Couples/ Family therapy sessions are often 80 minutes at a rate of $165 per session. The group therapy rate Payment is $45 per hour session. My practice is “fee for service” and that means that fees are due at the time of your appointment. Additional time the session in the form of exact-amount cash, check (insufficient-funds checks will be charged in 15-minute increments. Payments are to be made immediately following each session or previous to returned upon full payment of the session if distance counseling. I accept cash, checks, debit cards and credit cards. If there is a original amount plus $25.00 for any returned check), the charge will be $35. If you indicate that a third party will be paying for any portion of your bill, an Authorization for Release of Confidential Information would need to be signed. This would allow me to contact that individual and share information regarding your billing/ payment arrangements. Please be aware that if your outstanding balance exceeds $95, I will not be able to schedule further appointments until the balance is paidor credit/debit card. In the event that you miss your scheduled appointment time or cancel less than 24 hours, your credit card or debit card on file will be automatically charged. By signing this document, you agree to such cancellation and returned check fees. I reserve the right to terminate our counseling relationship if more than 2 four sessions are missed without proper notification. I charge my hourly rate in quarter hours for phone calls over 10 minutes in length, email correspondence, reading assessments or evaluations, writing assessments or letters, and collaborating with necessary professionals (with your permission) for continuity of care. All costs for services outside of session will be billed to your credit/debit card on file.

Appointments and Cancellations. You are responsible for attending each appointment you agreed upon. You agree to adhere to the following policy: If you are prevented from keeping a scheduled appointment, you MUST notify me 24 hours in advance. If I do not receive a 24-hour advance notice, you will be responsible for paying $90 for anyone using their insurance and the full fee rate for the session you missedany private pay services, and that such fee cannot be billed to your insurance company. Psychotherapy is a uniquely personal service; therefore, consultations may be briefly interrupted. I will, from time to time, take time off for vacation, to attend seminars, and/or become ill. I will attempt to give you adequate notice in advance and will arrange coverage for any emergencies by a colleague. If I am unable to contact you directly due to circumstances out of my control, I will have a colleague our client care coordinator contact you to cancel or reschedule an appointment. FEES: My private pay rate Payment is $185 for the initial 90- minute assessment and $115 per 50- minute session. Couples/ Family therapy sessions are often 80 minutes at a rate of $165 per session. The group therapy rate is $45 per hour session. My practice is “fee for service” and that means that fees are due at the time of your appointment. Additional time the session in the form of exact-amount cash, check (insufficient-funds checks will be charged in 15-minute increments. Payments are to be made immediately following each session or previous to returned upon full payment of the session if distance counseling. I accept cash, checks, debit cards and credit cards. If there is a original amount plus $50 for any returned check), the charge will be $35. If you indicate that a third party will be paying for any portion of your bill, an Authorization for Release of Confidential Information would need to be signed. This would allow me to contact that individual and share information regarding your billing/ payment arrangements. Please be aware that if your outstanding balance exceeds $95, I will not be able to schedule further appointments until the balance is paidor credit/debit card. In the event that you miss your scheduled appointment time or cancel less than 24 hours, your credit card or debit card on file will be automatically charged. By signing this document, you agree to such cancellation and returned check fees. I reserve the right to terminate our counseling relationship if more than 2 3 sessions are missed without proper notification. I charge my hourly rate in quarter hours for phone calls over 10 minutes in length, email correspondence, reading assessments or evaluations, writing assessments or letters, and collaborating with necessary professionals (with your permission) for continuity of care. All costs for services outside of session will be billed to your credit/debit card on file. In-home/On-site therapy services offer people comfort and flexibility. In-home/ On-site services are offered at our regular hourly rate. Cost for travel is based on the regularly hourly rate and is determined by time it takes for the therapist to travel from the office to your home or requested place of session and back. Time is configured by therapist tracking and logging actual time or internet sites such as Google, Bing, Mapquest, etc. to determine travel time.

Appointments and Cancellations. You are responsible for attending each appointment you agreed upon. You agree to adhere to the following policy: If you are prevented from keeping a scheduled appointment, you MUST notify me 24 48 hours in advanceadvance to cancel or reschedule your appointment. If I do not receive you cancel or reschedule more than once in a 2448-hour advance noticetime period, you we will be responsible discuss your need, desire and motivation for paying the full fee for the session you missed, and that such fee cannot be billed to your insurance companytreatment at this time. Psychotherapy is a uniquely personal service; therefore, consultations may be briefly interrupted. I will, from time to time, will periodically take time off for vacation, to attend seminars, and/or become ill. I will attempt to give you adequate notice in advance and will arrange coverage for any emergencies by a colleaguenotice. If I am unable to contact you directly due to circumstances out of my control, I will have a colleague contact you to cancel or reschedule an appointment. FEES: My private pay rate fee for each 45-minute session is $185 for the initial 90- minute assessment and $115 per 50- minute session150.00 or a discounted fee if worked out in advance. Couples/ Family therapy sessions are often 80 minutes at a rate of $165 per session. The group therapy rate Payment is $45 per hour session. My practice is “fee for service” and that means that fees are due at the time of your appointment. Additional time the session in the form of exact-amount cash, check (insufficient-funds checks will be charged in 15-minute increments. Payments are to be made immediately following each session returned upon full payment of the original amount plus $35.00 for any returned check), or previous to the session if distance counseling. I accept cash, checks, credit/debit cards and credit cardscard. If there is a returned check, the charge will be $35. If you indicate that a third party will be paying for any portion of your bill, an Authorization for Release of Confidential Information would need to be signed. This would allow me to contact that individual and share information regarding your billing/ payment arrangements. Please be aware that if your outstanding balance exceeds $95, I will not be able to schedule further appointments until the balance is paid. In the event that you miss your scheduled appointment time or cancel less than 24 48 hours, your credit card or debit card on file will be automatically charged. By signing this document, you agree please refer to such cancellation the “Appointments and returned check feesCancellations” policy above. I reserve the right to terminate our counseling relationship if more than 2 sessions are missed without proper notification. I charge my hourly rate in quarter hours for phone calls over 10 minutes in lengthany communication such as phone, text, email or postal mail correspondence, reading assessments or evaluations, writing assessments or letters, and collaborating with necessary professionals (with your permission) for continuity of care. All costs for services outside of session will be billed to your creditcredit card or required of you via check or cash. In-home/debit card On-site therapy services offer people comfort and flexibility. In-home/ On-site services are offered at a regular hourly rate. Cost for travel is based on filethe regular hourly rate and is determined by the time it takes for the me to travel from the office to your home or requested place of session and back. Time is configured by tracking and logging actual time or internet sites such as Google, Bing, Mapquest, etc. to determine travel time.

Appointments and Cancellations. You are responsible for attending each appointment you agreed upon. You agree to adhere to the following policy: If you are prevented from keeping a scheduled appointment, you MUST notify me 24 hours in advance. If I do not receive a 24-hour advance notice, you will be responsible for paying the full fee for the session you missed, and that such fee cannot be billed to your insurance company. Psychotherapy is a uniquely personal service; therefore, consultations may be briefly interrupted. I will, from time to time, take time off for vacation, to attend seminars, and/or become ill. I will attempt to give you adequate notice in advance and will arrange coverage for any emergencies by a colleague. If I am unable to contact you directly due to circumstances out of my control, I will have a colleague contact you to cancel or reschedule an appointment. FEES: My private pay rate fee for each session is $185 for the initial 90- minute assessment and $115 per 50- minute session150.00. Couples/ Family therapy sessions are often 80 minutes at a rate of $165 per session. The group therapy rate Payment is $45 per hour session. My practice is “fee for service” and that means that fees are due at the time of your appointment. Additional time the session in the form of exact-amount cash, check (insufficient-funds checks will be charged in 15-minute increments. Payments are to be made immediately following each session or previous to returned upon full payment of the session if distance counseling. I accept cash, checks, debit cards and credit cards. If there is a original amount plus $25.00 for any returned check), the charge will be $35. If you indicate that a third party will be paying for any portion of your bill, an Authorization for Release of Confidential Information would need to be signed. This would allow me to contact that individual and share information regarding your billing/ payment arrangements. Please be aware that if your outstanding balance exceeds $95, I will not be able to schedule further appointments until the balance is paidor credit/debit card. In the event that you miss your scheduled appointment time or cancel less than 24 hours, your credit card or debit card on file will be automatically charged. By signing this document, you agree to such cancellation and returned check fees. I reserve the right to terminate our counseling relationship if more than 2 sessions are missed without proper notification. I charge my hourly rate in quarter hours for phone calls over 10 minutes in length, email correspondence, reading assessments or evaluations, writing assessments or letters, and collaborating with necessary professionals (with your permission) for continuity of care. All costs for services outside of session will be billed to your credit/debit card on file. In-home/On-site therapy services offer people comfort and flexibility. In-home/ On-site services are offered at our regular hourly rate. Cost for travel is based on the regularly hourly rate and is determined by time it takes for the therapist to travel from the office to your home or requested place of session and back. Travel time is configured by thetherapist tracking and logging actual driving time or using Internet sites such as Google, Bing, Mapquest, etc. to determine travel time.

Appointments and Cancellations. You are responsible for attending each appointment you agreed upon. You agree to adhere to the following policy: If you are prevented from keeping a scheduled appointment, you MUST notify me 24 hours in advance. If I do not receive a 24-hour advance notice, you will be responsible for paying the full fee for the session you missed, and that such fee cannot be billed to your insurance company. Psychotherapy is a uniquely personal interpersonal service; therefore, consultations our work together may be briefly interruptedinterrupted but works better when interruptions are minimized. I will, from time to time, take time off for vacation, to attend seminars, and/or become ill. I will attempt to give you adequate notice in advance and will arrange coverage for any emergencies by a colleague. If I am unable to contact you directly due to circumstances out of my control, I will have a colleague contact you to cancel or reschedule an appointment. FEES: My private pay rate fee for each session is $185 for the initial 90- minute assessment and $115 $ (per 50- minute session). Couples/ Family therapy sessions are often 80 minutes at a rate Payment is due before the beginning of $165 per session. The group therapy rate is $45 per hour session. My practice is “fee for service” and that means that fees are due at the time session in the form of your appointment. Additional time exact-amount cash, check (insufficient-funds checks will be charged in 15-minute increments. Payments are to be made immediately following each session or previous to returned upon full payment of the session if distance counseling. I accept cash, checks, debit cards and credit cards. If there is a original amount plus $35.00 for any returned check), the charge will be $35. If you indicate that a third party will be paying for any portion of your bill, an Authorization for Release of Confidential Information would need to be signed. This would allow me to contact that individual and share information regarding your billing/ payment arrangements. Please be aware that if your outstanding balance exceeds $95, I will not be able to schedule further appointments until the balance is paidor credit/debit card. In the event that you miss your scheduled appointment time or cancel less than 24 hours, your credit card or debit card on file will be automatically charged. By signing this document, you agree to such cancellation and returned check fees. I reserve the right to terminate our counseling relationship if more than 2 two sessions are missed without proper notification. I also reserve the right to terminate our counseling relationship if there is a problem of chronic cancellations (defined as 2 consecutive months with two or more cancellations each month). I charge my hourly rate in quarter hours for phone calls over 10 minutes in length, email correspondence, reading assessments or evaluations, writing assessments or letters, and collaborating with necessary professionals (with your permission) for continuity of care. All costs for services outside of session will be billed to your credit/debit card on file.