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  • INFORMED CONSENT TO ASSUME RESPONSIBILITY FOR PAYMENT FOR COUNSELING SERVICES

    Claudia Ward, MC, LPC AZ 18593 info@newwaycounselingaz.com   623-628-9737
  • I,, agree to pay for counseling services, and other clinical services, according to the fee agreement between the counselor and the client. I understand the following terms apply to this agreement:

    • The fee for counseling, consultation, letter or report writing, or other clinical services is $120 per 45-60 minute session. The initial appointment can run approximately 90 and the fee is $140 dependent on the length of the session. All fees are due at time of service, unless other arrangements have been made with A New Way of Becoming Counseling Services LLC.  
    • Because we understand that financial circumstances can change, please inform the counselor of any changes in either your ability or willingness to pay. Services will be terminated if timely payment is not made, as agreed to by this consent. 
    • Per the informed consent, broken appointments where the counselor is not notified 24 hours or more in advance are subject to the full session fee. A New Way of Becoming Counseling Services LLC holds an approved credit card on file, and this fee will be charged automatically.      


    Please complete this section in full:

  • Card Number       
    Expiration Date
    Security Code
    Billing Zip Code
    This agreement supplements any and all previous informed consents.  

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