Use of Credit Cards. Eastside Counseling and Coaching permits payment with credit card, cash or check. If you chose to pay with a credit card, please submit the number and expiration date below. Your credit card will be charged after your session and a receipt will be e-mailed to you. I agree to remit payment by credit card for counseling services.
Appears in 1 contract
Sources: Counseling Agreement
Use of Credit Cards. Eastside Counseling and Coaching permits payment with credit card, cash or check. If you chose to pay with a credit card, please submit the number and expiration date below. Your credit card will be charged after your session and a receipt will be e-mailed to you. Many times, I agree to remit payment by will collect a credit card number even if you are paying with insurance so I can charge for counseling services.co-pays. Card # Exp Date: Signature Date
Appears in 1 contract
Sources: Adolescent Counseling Guidelines and Agreement Form