BIPP Payment Form
Please complete the required information below to process your BIPP group payment. For questions please contact the Safer Path Administrative team at 830.569.2001 option 2.
BIPP Client Information
*
First Name
Last Name
Email
*
example@example.com
Date
*
-
Month
-
Day
Year
Date
My Products
prev
next
( X )
Weekly BIPP Fee
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
BIPP Intake Appointment
Payments must be made before the Intake appointment or at the time of the appointment. Service will not be provided if payment is not made. Payments will not be refunded if the client is a no-show. The payment will be considered a donation to Safer Path.
$
40.00
Weekly BIPP (Reduced Fee)
**IMPORTANT** This ammount is only to be paid for those who qualify
$
15.00
Quantity
1
2
3
4
5
6
7
8
9
10
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