THIS FORM IS ONLY COMPLETED AT THE REQUEST OF YOUR ASSIGNED THERAPIST.
INSURANCE: We operate on a sliding scale and are unable to take insurance since we are not in network with insurance companies. On request our therapists will provide a receipt with proper codes that you can submit to your insurance company for out-of-network reimbursement of our fee.
FEE/SCHOLARSHIPS: Session fees are negotiated by the assigned therapist considering the client situation and our sliding scale. Full pay on the scale is set at $150 per fifty-minute session. For those in need we can offer a reduced fee through our Scholarship Program which is offered on a first come, first served basis, and is limited to 12 sessions followed by re-evaluation. When available our master’s level interns provide quality counseling at a reduced rate.
SPONSORSHIP/DONATIONS: Sponsorship is provided by community and church support through donations with 100% of the funds raised used to pay for direct client care. If you or someone you know are interested in donating to our Scholarship Fund please donate through our website at www.thepeacemakercenter.org or mail a check to 368 W Uwchlan Ave, Downingtown PA 19335 or contact us at 610-269-2661. Donations are tax deductible with receipts available upon request.
If you have an individual, church, or organization sponsoring you, please indicate the following:Sponsor Name Sponsor Phone Sponsor Email # of Sponsored Sessions