SLIDING SCALE CLIENTS CONTRACT


SLIDING SCALE CLIENTS

Behavioral Health Payment AND Cancellation Policy

Welcome to Anchorpoint Counseling Ministry. We are committed to providing you the finest care, and would like you to understand that payment of your bill is necessary for maintaining quality care. For this reason, we have adopted the following financial policy which we require you to read, agree and to sign prior to receiving any behavioral health care services from us.

Payment is due at the time of service. Your therapist will determine the amount you will be responsible for per session at your initial appointment. After two (2) unpaid sessions, your Counselor will notify our billing personnel who will invoice the amount due. Invoices will be due upon receipt. If you are having difficulty paying your fees speak with your Counselor to discuss this issue.

CANCELLATION POLICY: You are responsible to be on time for your scheduled appointments. If you find it necessary to cancel an appointment, you are responsible for contacting your Counselor a minimum of 24 hours advanced notice. You may call the office (412-366-1300) to speak or leave a message for your Counselor. Failure to notify your Counselor you will be assessed a cancellation fee to be paid at your next appointment. The fee is determined by the agreed amount due per session OR $20, whichever amount is less.

NOTICE OF CHANGES: You are responsible for notifying Anchorpoint Counseling Ministry of any and all relevant personal information changes. (New addresses/contact numbers)

RETURN CHECKS POLICY: If your personal checks are returned for NSF, you will be billed a fee up to $25 to cover bank fee expenses. Subsequent payments for appointments must be paid in cash or money order.

I have read, understand and agreed to comply with this policy:

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Document name: SLIDING SCALE CLIENTS CONTRACT
lock iconUnique Document ID: 5bfbe606e7dad61bf1b53b809e1e16e0fd330642
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May 21, 2020 1:09 pm ESTSLIDING SCALE CLIENTS CONTRACT Uploaded by Lisa Feraco - [email protected] IP 162.144.177.109
May 28, 2020 11:52 am EST Document owner [email protected] has handed over this document to [email protected] 2020-05-28 11:52:15 - 162.144.177.109