Online Payment

Your Name:
Your Email Address:

Charge this Amount:
Invoice Number
(if known):
Credit Card Type:
Credit Card Number:
Card Expires (mm/yy):
Billing Address:
Zip code:
Checking the box below acknowledges that you hereby authorize us to charge your credit card for the total amount as stated above.

Do I have to pay for my visit at the time of my appointment?

If your insurance requires you to pay a co-pay, then you must pay this co-pay at the time of your appointment.

How much is my co-pay?

Your co-pay varies on your insurance provider and the contract your employer has negotiated with your insurance company. In order to accommodate the needs and requests of our clients, we have enrolled in numerous managed care insurance programs. We are pleased to be on these provider lists in order to provide this service to you. It is, however, extremely difficult, if not impossible, for us to keep track of all the individual requirements of each of these plans. Each plan has different stipulations regarding how services may be rendered, and the number of visits allowed - which does not automatically coincide with the number of visits available. Even within the same insurance company, the plans differ depending upon the contract your employer has negotiated, as mentioned previously.

Providing quality care is our primary concern, and we are more than willing to provide that care within your insurance contract guidelines. However, we do not know those guidelines and you need to let us know exactly what your insurance terms are regarding referral numbers, number of visits, type of sessions, deductibles, payment and copayments. Unforunately if you do not inform us of these specific requirements in your insurance contract, and we subsequently provide services that are not covered, we will have no choice but to bill you directly for those services. Payment of unauthorized services is then your responsibility. Fees not covered by your insurance company are due as you leave the office. If this should be the case, we offer payment plans to ensure your treatment does not go unfinished. If you have a question on whether we accept your insurance, please call our office at (512)454-5851.