Use this form to submit your remote counseling session payments. Once you hit submit, the page will redirect to Paypal to complete the transaction. Follow the prompts on the screen to pay with a Paypal Account, Credit or Debit Card. Please enable JavaScript in your browser to complete this form.Are you meeting with your counselor remotely? *YesNo Please pay your bill in person with your counselor at the time of your appointment. No need to submit this form. Name *FirstLastEmailPhone *Address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEnter your amount due - Assigned by your counselor *If you do not know your amount due, contact your counselor.Comment or MessageMessageSubmit