Forms and Policies

Payment for Services

Payment of deductibles, co-payments, co-insurance, and self-pay amounts are due at the time of service. As a courtesy to you, we will file your primary and secondary insurance.

 In divorce situations, the parent bringing the child to The Counseling & Wellness Center for care will be responsible for all charges during treatment.

 We will first send a letter requesting payment or call to discuss payment options for any unpaid balance. We reserve the right to use a collection agency. No clinical information is given to collection agencies.

Non-Discrimination/Sliding Fee Discount Policy

Download our non-discrimination and sliding fee discount policy (PDF)

Sliding fee application and fee schedule

Download our sliding fee application and fee schedule (PDF)

Case Management Service and Coordination of Care

Download an informational sheet on case management services (PDF)

Late Cancellation and No Show Fee

A $40 fee will be charged for appointments cancelled or missed with less than 24 hours notice. If you need to cancel an appointment, please call our office during business hours: Monday-Thursday 9 AM- 5 PM

Please Be On Time

Patients who are 10 minutes or later for appointments may be rescheduled. This decision will be made by the nursing staff.