Common use of Payment and Fees Clause in Contracts

Payment and Fees. I understand that payment is due at the time of service. Payment can be made with cash or credit card. I understand that regardless of the form of payment I use, I am required to complete a Credit Card Authorization form with a currently active card. I understand that the fees for service are as follows: $250 for a 60 minute individual, couples or family session. I agree that should I need to cancel an appointment, I will notify Xx. Xxxxxx Xxxxxxxxx Colmer, LMFT at least 24 hours in advance. If I fail to do so, I understand that a full session fee of $200 will be charged to the credit card I have on file.

Appears in 1 contract

Samples: Therapy Agreement

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Payment and Fees. I understand that payment is due at the time of service. Payment can be made with cash or credit card. I understand that regardless of the form of payment I use, I am required to complete a Credit Card Authorization form with a currently active card. I understand that the fees for service are as follows: $250 225 for a 60 minute individual, couples or family session. I agree that should I need to cancel an appointment, I will notify Xx. Xxxxxx Xxxxxxxxx Colmer, LMFT at least 24 hours in advance. If I fail to do so, I understand that a full session fee of $200 will be charged to the credit card I have on file.

Appears in 1 contract

Samples: Therapy Agreement

Payment and Fees. I understand that payment is due at the time of service. Payment can be made with cash or credit card. I understand that regardless of the form of payment I use, I am required to complete a Credit Card Authorization form with a currently active card. I understand that the fees for service are as follows: $250 for a 60 minute individual, couples or family session. I agree that should I need to cancel an appointment, I will notify Xx. Xxxxxx Xxxxxxxxx Colmer, LMFT at least 24 hours in advance. If I fail to do so, I understand that a full session fee of $200 250 will be charged to the credit card I have on file.

Appears in 1 contract

Samples: Therapy Agreement

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Payment and Fees. I understand that payment is due at the time of service. Payment can be made with cash or credit card. I understand that regardless of the form of payment I use, I am required to complete a Credit Card Authorization form with a currently active card. I understand that the fees for service are as follows: $200 for a 65 minute individual, $250 for a 60 75 minute individual, couples or family session. I agree that should I need to cancel an appointment, I will notify Xx. Xxxxxx Xxxxxxxxx Colmer, LMFT at least 24 hours in advance. If I fail to do so, I understand that a full session fee of $200 will be charged to the credit card I have on file.

Appears in 1 contract

Samples: Therapy Agreement

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