Therapy or Therapeutic Visitation Payment

Therapy or Therapeutic Visitation Payment

Payments are due 24 hours in advance of your scheduled visit. Cancellations without a 24 hour notice are not refundable.
Session For*

First NameLast Name
Scheduled Session Date*

MonthDayYear
Therapist Name
Payee Name*

First NameLast Name
Payee Phone Number*
Payee Email*
Select one of the following (Only one visit per transaction)
prevnext( X )
1 Hour Session
$105/hr plus paypal fees

$108.15



2 Hour Session
$105/hr plus paypal fees

$216.30



3 Hour Session
$105/hr plus paypal fees

$324.45



30 minute session (prior approval needed)
$52.50 plus paypal fees

$54.08 Quantity



Total

$0.00
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