An adult client is considered responsible for his/her own account. The responsible party for a minor account (under the age of 18) rests with the parent/guardian seeking services.
Do not fill this page if information is same as above
The above informationis accurte and Complete to the best of my knowledge
APPOINTMENT REMINDER/CONFIRMATION CALLS
If ther is a mental health Emergency, Please call 911 or go to the nearest Emergency room.
Should ther be a URGENT need to speak with your Therapist
Call 616-296-2130 during business hours
231-923-2678 if after business hours.
Our staff will work with you to reach your therapist if at all Possible
Please be advised htere will be a regular session fee charged based on the time used and are often not billable to your insurance company.
I understand that there are Fees associated to phone calls with my therapist and will I will be personally responsible for those charges.
PUNCTUALITY AND ATTENDANCE
When you make an appointment, your mental health Professional will reserve that time for you. it is your responsibility to keep the appointment and apply yourself wholeheartedly to benefit from each session. Frequent cancellaation will also obstruct your progress in treatment and may result in the discontinuance of treatment.
If you are late, you still will be charged for the full scheduled appointment. If you miss and appointment or cancel less than 24hours in advance there is a service charge of 50% of the standard fee for the scheduled service which is Not coverd by your Insurance. this is not a penalty, but rather a payment for time reserved for you. It is your responsibility to contact the office of Copassionate Christian Counseling and reschedule your cancelled appointment.
I understand that 24 hour notice muct be given for all cancelled appointments to avoid the 50% cancellation fee.
COST OF TREATMENT
KRISTINE TYPE SOMETHING HERE
WHAT TO EXPECT FROM TREATMENT
kRISTINE TYPE HERE
CONSENT FOR TREATMENT FORM
KRISTINE TYPE HERE PLEASE
KRISTINE TYPE HERE
CONSENT FOR TREATMENT OF MINORS.( IF THIS PERTAINS TO YOU)