DEAN & HOLLYKEM SUNSERI 

CLIENT INFORMATION/FINANCIAL SHEET

 Counseling Services

Length of appointments:  (Office, home, work, school. telephone)

• In general, Face to Face Appointments are 60 or 90 minutes.

• Telephone Appointment Vary

• Telephone, Client Advocacy, Written Documents, Research and Travel Time are billed at 10 Minute Increments

Fees For Appointments:

• All Services are billed at an hourly rate. (Billed at 10 Minute Increments)  Contact us for the fee schedule.

Billing:

• Payment is required at each session unless credit card is on file.  Our policy is to accept cash, check or credit cards.  There is a $20 charge for NSF checks.

Changing Appointments:

• If you need to change your appointment time, please call and we will attempt to reschedule.  If you do not give the required 24 hour notice of cancellation you will be expected to pay for the appointment.

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Signature                 Date                            Counselor            Date