My therapy practice utilizes Ivy Pay for accepting payments. Ivy pay is a card payment system designed specifically for therapists and their clients. 

Ivy Pay works with your debit card, credit card, HSA or FSA card. It is HIPAA-secure, and it keeps our therapeutic relationship confidential.

To set up your account, I will send you an invitation text via Ivy Pay's system with a charge for $1. The text you receive will come from a phone number in Ivy Pay's system (not me) and will be worded similarly to the following: "You've been invited to use Ivy. To accept and pay for sessions with a card on file, go to [link]." 

I ask that you use the link to set yourself up in the system at least 24 hours prior to your next appointment time. It is quick, easy, and very secure.

You can tap on the link in your invite text to be taken to the secure 'Add Card' form. Scroll down on the 'Add Card' form, add your card details, and tap 'Save & Pay.' Your card will be encrytped and stored in Ivy Pay's secure servers, and you will be charged $1. When I charge you for your next payment, I will subtract the $1 you already paid.

Just to be clear, I personally will not have access to your financial information--it will be on file and maintained securely through Ivy Pay. On your card statement, it will appear as as "Ivy Labs, Inc," "Purchase Ivy*Session," or a similar name.

Going forward, I will have Ivy Pay charge your card on the day of your session. You will receive a text confirmation whenver I use Ivy Pay to charge your card. This will appear in the same thread as your original invite text. (Tip: if you ever need to update your payment card details, just tap on the invite link from the original text to update your card).

Rates, Billing and Payments

The standard charge between myself and my therapist will be $100 per 60 minute session, $75 per 45 minute session, and $50 per 30 minute session. Insurance copays vary by plan, and your therapist will notify you of the designated amount for your sessions. The copay amount is a fixed rate set by the insurance and does not typically decrease for shorter sessions. (When this happens, it can be more cost-effective to meet every other week for an hour than weekly for 30 minutes).

A scheduled appointment means that time is reserved only for you:

• When possible, cancellations will need to be made 24 hours in advance. You may call, text, or email to cancel. Late cancellations within 24 hours are subject to a late fee of $25 (unless the absense is excused by the therapist when notified of an emergency or other valid reason for needing to cancel with short notice. Valid reasons, include, but are not limited to lack of childcare for the session, illness within the household, not having a private space for the session, or an unexpected work conflict).
• If you are not present in the video session after 5 minutes, I will text or email you (if permitted under your contact preferences).
• If you have not shown up after 15 minutes past the appointment time, I will attempt to call you. If there is no response, this is considered a no-show. No call, no shows are charged at the full session rate and can only be waived in the event of an emergency.
• Please be aware that multiple late cancellations or 2 no show appointments may lead to termination from therapy services.

**By signing this form, I am confirming that I have read the above information and that all of my questions about the process for using Ivy Pay to cover session costs, copays, or fees have been answered. I provide my consent for my therapist to complete charges as designated above.**