Common Contracts
1 similar Cash Payment Agreement contracts
Cash Payment AgreementCash Payment Agreement • September 28th, 2020
This is to acknowledge the agreement between Person Responsible for Payment and Integrative Counseling Services, PC (ICS) to accept private pay as payment for services rendered. The amount listed above is for therapy services only and does not include costs for reports, copies of records, collaboration with individuals outside of ICS, etc, they will be billed at the fee scheduled rates.
