policies and forms

Payment for Services

Payment of deductibles, co-payments, co-insurance, and self-pay amounts are due at the time of service. As a courtesy to you, we will file your primary, and secondary insurance.


In divorce situations, the parent bringing the child to The Counseling & Wellness Center for care will be responsible for all charges during treatment.


For any unpaid balance, we will first send a letter requesting payment or call to discuss payment options. We reserve the right to use a collection agency. No clinical information is given to collection agencies.

Late Cancelation and No Show Fee

A $50 fee will be charged for appointments canceled or missed with less than 24 hours’ notice. If you need to cancel an appointment, please call during office hours. Monday-Thursday 9A-5P

Intake and Other Office Forms

Click on the Form(s) below. Complete, sign, and bring them with you to your appointment. Be sure to arrive 15-20 minutes early for your first appointment. This will help us keep you on schedule. Contact our office at 740.401.3088 if we can be of any assistance to you.