Client Fee AgreementClient Fee Agreement • November 2nd, 2021
Lauren Reiter LCSWClient Fee Agreement • July 6th, 2023
Like many seasoned professional therapists with extensive specialization, I’ve chosen to not work in-network with insurance companies because of the inherent conflict between goals of the insurance company and needs of my clients. If you chose to use your out-of-network benefits, I will be happy to provide you with a receipt that will allow you to do this.
Debbi J. Dunbar, MS, LPCClient Fee Agreement • December 23rd, 2020
£ Cancellations must be received at least 24-hours in advance of your scheduled appointment; otherwise you will be charged $175 for the time reserved for you.
CLIENT FEE AGREEMENTClient Fee Agreement • July 10th, 2018
We are in-network providers for most major insurance companies. As a courtesy to you, we work directly with your insurance company. Verification of coverage is not a guarantee of claim payment. It remains your responsibility to understand your plan’s limitations, deductibles and exclusions. For benefit coverage questions, please call the customer/member service number on the back of your insurance card. We have no authority to make specific representations to you regarding coverage of services. It is your responsibility to provide us with updated information when your insurance policy changes or your coverage terminates.
Client Fee AgreementClient Fee Agreement • April 1st, 2020
Client/Fee Agreement - NQ7691Client/Fee Agreement • September 3rd, 2019
ContractClient Fee Agreement • September 23rd, 2020
Client's Last Name First Name MI Client's Date of Birth Street Address City State Zip Home Phone Work Phone Cell Phone Is it okay to leave a message? Yes No Is it okay to leave a message? Yes No Is it okay to leave a message? Yes No
Client Fee Agreement Initial Adviser ChargesClient Fee Agreement • November 15th, 2016
Lisa Geraud, MA, MS, RD, LMFTClient Fee Agreement • June 16th, 2021
The following information will help you become acquainted with my office, schedule, credentials, specialties, counseling style and policies. Please discuss any questions with me in session or by telephone call at any time after you have read the following information.
Client/Fee Agreement - NQ7691Client/Fee Agreement • September 3rd, 2019
CLIENT FEE AGREEMENTClient Fee Agreement • October 9th, 2017
This Agreement is supplementary to our Terms and Conditions of Engagement and sets out the basis on which we charge for the services. It is agreed that:
CLIENT FEE AGREEMENTClient Fee Agreement • November 7th, 2016
FLAT FEES OR RETAINERS ARE NON-REFUNDABLE. THIS FEE IS NON- REFUNDABLE BECAUSE OF THE MINIMUM FEE THIS FIRM CHARGES TO ENTER MY CASE IS BASED ON THE FIRM’S YEARS OF EXPERIENCE, EXPERTISE, LIABILITY, AND EXCLUSION OF OTHER CLIENTS WHICH THIS LAW FIRM COULD REPRESENT.
CLIENT FEE AGREEMENT FOR 2020 INCOME TAX RETURN PREPARATIONClient Fee Agreement • January 12th, 2020
Your payment of the fees must be included with this document and paid in full before your return is filed. If you have any questions as to what your total fees are, please feel free to call or text Richard, Teri or Elaine. Thanks
CLIENT FEE AGREEMENTClient Fee Agreement • November 26th, 2022
Client Fee AgreementClient Fee Agreement • June 15th, 2016
Client Fee AgreementClient Fee Agreement • January 12th, 2016
As a nonprofit community agency, Family Service Association has various sources of funding. These sources include United Way, local tax moneys, benefactors and State and Federal sources. However, this support does not cover the full cost of providing counseling services and therefore we must charge a fee for our services.
Client Fee Agreement Ongoing Adviser ChargesClient Fee Agreement • November 15th, 2016
Client Fee AgreementClient Fee Agreement • October 14th, 2020
Payment is due at the time of services provided. Payment includes out of pocket expenses, deductibles, coinsurance and copayment amounts. The full fee for professional psychotherapy services is $160.00 for individual, couples and family therapy. Group fees are determined separately. If no payment is made for two consecutive appointments, services will be suspended until some payment is made.
Client Fee AgreementClient Fee Agreement • August 21st, 2024
CLIENT FEE AGREEMENTClient Fee Agreement • September 11th, 2020
CLIENT FEE AGREEMENTClient Fee Agreement • June 20th, 2017
BETWEEN: A1 Certifier Pty Ltd - ACN 622270786 (A1C, We’, ‘us’ or ‘our’) AND: The client(s) person entering into contract (you)Client Fee Agreement • June 3rd, 2022 • Queensland
This client fee agreement sets out the work that A1C will perform for you and how we will charge you for that work. We regret that this agreement must be so formal, but it is important for you to understand that you are entering into a professional relationship with us. A1C feel that it is important for you to fully understand all of the terms of our relationship as this understanding will give both you and A1C a firm foundation for our relationship.
Debbi J. Dunbar, MS, LPCClient Fee Agreement • September 8th, 2021
£ Cancellations must be received at least 24-hours in advance of your scheduled appointment; otherwise you will be charged $175 for the time reserved for you.
Client Fee AgreementClient Fee Agreement • July 11th, 2020
Debbi J. Dunbar, MS, LPCClient Fee Agreement • February 6th, 2022
□ Cancellations must be received at least 24-hours in advance of your scheduled appointment; otherwise, you will be charged $190 for the time reserved for you.
Client & Fee AgreementClient & Fee Agreement • December 16th, 2020
This document forms your Client Agreement with GSI Wealth Management Ltd and GSI Wills and Trusts LLP and is designed to come into force upon receipt.
