If the client decides to continue with additional sessions after the determined amount of sessions, the client may either seek more financial assistance from the referring facility or they may have to fund their own counseling. If the organization elects to partially fund the referral's counseling, it is assumed that the client has been advised of their responsibility to pay a portion of the bill prior to their intake at Heartland Christian Counseling.
The signatures below indicate that this form has been reviewed between a HAP Representative of the Leadership of the Organization and the potential Client being referred to for counseling at Heartland.