Billing for all telehealth services will be by credit card unless prior arrangements have been made with your therapist or the office staff. We do not accept debit cards or American Express cards.
We will keep your credit card on file and use it after each session for copays, deductibles and/or the session fee. The credit card information you provide will be stored in our payment processing system which is encrypted and HIPPA compliant.
Credit Card Authorization:
Charges for telepsychology appointments with my therapist from Associates in Health Psychology will be paid by using a credit card within 2-3 days of your session. By typing my name, using my electronic signature, or signing below, I authorize my AHP therapist or the AHP office staff to charge my credit card to pay my copay, deductibles and other fees related to my telepsychology sessions. I also allow “signature on file" to appear on my credit card receipt so it will not be necessary for me to sign receipts. I understand that my information will be saved for future transactions on my account.
You may cancel this authorization at any time by notification in writing to your AHP therapist or the AHP office staff. This authorization will remain in effect while utilizing telehealth or until canceled. When you are at an AHP office for sessions, your therapist will need to swipe your credit card. If you wish to continue to have “signature on file,” you will not need to sign your credit card at each visit.
YOUR THERAPIST WILL ASK FOR YOUR CREDIT CARD INFORMATION PRIOR TO, OR AT THE TIME OF, YOUR FIRST TELEHEALTH SESSION. PLEASE SIGN BELOW INDICATING YOUR AGREEMENT TO THE ABOVE POLICIES.