Credit Card Authorization
In order to hold your appointment with clinicians at PSP, we ask that you place a credit card on file. In the case that an appointment is canceled outside of our policy (see below), you will be charged for the cost of the appointment ($300 for psychiatric intake appointments, $150-200 for therapy intake)

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Email address *
Client Name *
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Name on Credit Card *
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Credit Card Number *
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CSV *
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Credit Card Expiration Month *
Credit Card Expiration Year *
Billing Address *
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Billing City *
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Billing Zip Code *
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By Typing Your Name You Agree the Above Information is Correct *
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Summary of Cancellation Policy
Except in the case of an acute emergency or illness, we require a two business days notice for any cancellation; otherwise, your account will be charged for the visit. If our office is closed, leave a message on our office voice mail, the Valant portal, or send us an email to inform us of your cancellation.

***CANCELLATION POLICY***

We have a two-day, two-tier cancellation notice policy.

If you need to cancel or reschedule with less than 48 hours notice, you will be charged $50.

If you contact us within 24 hours of your appointment, you will charged your full appointment fee.

Psychiatric Fees (Amy Sharma and Geoffrey Fong): $300 for intake appointments and $150 for follow up appointments
Counseling Fees Vary by clinician from $250-$125, refer to the intake paperwork provided.
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