I am willingly and of my own accord entering psychotherapy with Brent Carter MA, MFT for the purpose of addressing a variety of concerns that may be mental, emotional, personal and/or interpersonal.

As payment for the delivery of said services I agree to pay the fee of $200.00 per 50 minute session (Ind), (sessions generally run closer to one hour). I understand that full payment is due no later than 15 minutes prior to the scheduled start time of that day’s session.

I understand that my therapist will send me an Invoice for said services the day of services and that my payment will be made electronically by either Zelle or Pay Pal (Pay Pal includes a $10.00 that I must pay and that will be added onto the base charge) within the specified time frame.

I also understand that I am free to cancel or request rescheduling of an existing appointment but that the request must be made at least 24 hrs in advance of the session. The failure to cancel at least 24 hrs in advance will incur a $120.00 fee to be paid with 48 hrs of the missed appointment in same manner as session payments. I also understand that my therapist may grant exceptions to the cancellation policy in cases of medical or other unexpected emergency circumstances that make it difficult or impossible for me to cancel appropriately.

My signature below constitutes my full understand and consent to these guidelines.