​Revived Lives Counseling 

Consent and Service Agreement Form

Authorization to Release Form

Call Us:  779-205-9384

Office Policies

 

• The standard fee for a full session, 50-60 minutes, is $150.00 and payment is due at the time of service by check, cash or credit card.
• We accept many major insurance carriers.
• Many insurance policies have deductibles, which are the responsibility of the client and need to be met prior to the client paying the co-pay for each session.
• If there is a co-pay, it is due upon arrival and required for every visit.
• If you are a cash-paying client, payment is due at the time of service. We offer a sliding scale based on family income. Proof of income is required. 
• The parent or guardian of a minor is responsible for any incurred charges.
• There is a $60.00 charge for returned checks.
• We require at least a 24-hour notice when canceling or rescheduling an appointment. If cancelled within 24 hours of the appointment, the  charge is $75.