Extra Service Fee

“Other professional

services you may

need...”

Extra Services

Other professional services you may need include:

• Report writing

• Telephone conversations lasting more than 15 minutes

• Consulting with other professionals on your behalf

• Attendance at meetings on your behalf

• Preparation, copying and/or mailing of treatment summaries

• Any other service you may request of me.

Charges for extra services have an hourly rate of $150.00

For unscheduled telephone calls between sessions, my fee breaks

down by the quarter hour/fifteen (15) minute units.

Declined checks or charges

There is a surcharge of $40.00 on any check, debit card or credit

card declined or returned for insufficient funds.