Grace & Hope in Loss, LLC

Financial Policy

Rate per 55-60 minute session                          $65.

Rate per 75-90 minute session                 $80. - 95.

I am responsible for all charges and agree to pay when services are rendered.  If alternative payment arrangements are necessary, I must come to an agreement with Georgina Manahan in advance.  I understand that I am accountable for making those payments as arranged or the counseling relationship may be terminated.

In the event that I fail to pay my charges, I agree to pay all costs incurred to collect same.

I understand that I am responsible for all charges incurred due to no shows and last minute cancellations (less than 6 hours prior to the time of appointment).  At the discretion of the counselor, no shows and last minute cancellations are billed at half the regular session rate.

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Signature of Responsible Party                                                     Date