Financial Policy

If you have any trouble submitting this form, please download and print the pdf and fax it to us at (703) 530-9805. Download

I understand that I am directly and fully responsible to Calvary Counseling Center for all services rendered to me and/or members of my family by Calvary Counseling Center. I further understand that such payment is expected when services are rendered and is not contingent on any settlement, judgment or insurance payment by which I may eventually recover said fee. Calvary Counseling Center will provide me with receipts, which I can file with my insurance company for reimbursement consideration.

I understand that all services rendered by Calvary Counseling Center are final and non-refundable.

I understand that all diagnoses and opinions in reports and/or evaluation assessments are offered with a reasonable degree of psychological certainty.

I understand that all fees are non-refundable and/or transferable. 

I understand that no show fees and cancellation fees are $65.

I have read the above and understand my responsibilities in each instance regarding payment of services rendered.

 

NOTE: It is our policy to charge for telephone consultations lasting more than 5 minutes. The charge will be pro-rated on base rate of $125/hour. Cancelled phone or office appointments with less than 24 hours notice and all no-shows will be charged $65.