FINANCIAL AGREEMENT Credit Card Number on File: Jenine LaCoe respects your time and sets aside time to see you when you make an appointment with her. A session usually lasts 60 minutes and payment is due at the time of treatment. It is important that clients respect the therapist’s time as well. Clients wishing to cancel or change an appointment must give the counselor 24-hours notice. In most cases, the therapist will be able to accommodate another client if such notice is given. To impress upon clients the importance of giving advance notice when canceling appointments, the counselor requires a credit card number and information on file. If a client no-shows or cancels at the last minute or without giving 24 hours notice so that the slot may not be taken by someone else who is waiting for therapeutic care, the credit card will be charged for the full cost of the missed appointment. In addition, if payment is made by check and a check is returned, the owed amount will be charged to the credit card plus a $30 returned check fee.Once again, be warned – clients who miss appointments or cancel without 24 hours notice will be charged for a full missed appointment based on the hourly rate. Please provide credit card information here. Jenine LaCoe will be very respectful of this information and your rights to privacy: *
