Christian Counseling Centers of Indiana, LLC
Payment Agreement & Cancellation Policy
Please read the following agreement. It explains how to make and keep appointments, my cancellation policy, and my fee and payment policy as well as my policy on confidentiality and privacy.
- Payment is always due at the time of service.
- My fee is $90 for a 60 minute session.
- I accept the following forms of payment:
- Master Card
- There will be a $30.00 charge for checks returned for insufficient funds.
I do not accept insurance; however some insurance companies cover my services. You will need to check with your own insurance company to see what they will cover if anything. I leave filing for insurance reimbursement up to each client since I don’t have a staff available to do billing and collection and adding staff would create a need for me to raise session costs, which I try to keep down. A statement is always available for you to see or print out at www.Schedule.care and will have the insurance code numbers that you will need to file for your insurance. Please ask if you need additional statements or a different type of receipt.
Appointments can be made at any time from my web site www.cccoi.org at the appointment site www.Schedule.care if you need help scheduling you can email me at Dr.Boen@hushmail.com or call me at 260-413-5120 and leave a message and I will get back to you as soon as I can to help with the scheduling. My appointments are 60 minutes long. I prefer to work for longer periods at one time since it is often hard for people to schedule additional times due to busy schedules. This also allows us to get more work done in one session. .
It is your responsibility to remember and make appropriate arrangements to keep your appointment. If for any reason you cannot keep your appointment please call me as soon as possible or contact me by e-mail through your TherapyAppointment login at www.Schedule.care.
Cancellations received after your appointment and no shows will be charged at the full fee assigned to your appointment, except for personal emergencies or dangerous travel conditions due to the weather.
CONSENT FOR MENTAL HEALTH SERVICES
The State of Indiana requires all individuals sign a consent form before beginning services. Please complete the following information. Your returning this document electronically implies agreement and understanding of the Payment Agreement and Cancellation Policy aforementioned and your consent to the services provided. You and your spouse (if applicable) need to complete separate forms.