Session Funding – Other The form has been successfully submitted. Thank you!Agreement for Session FundingClient Name*Your Name*Address*Email*Phone*I understand that fees are due on a session by session basis at or before the time of the appointment unless agreed otherwise.I understand the fee for changes or cancellations without due notice, and missed appointments is payable regardless of the circumstances and is due at the time the change or cancellation is made.I understand that if any fees are outstanding further sessions may not be possible for the client until payment has been received.I give consent to the details provided on this form being safely stored for the purpose of invoicing for the duration of the therapy and until all outstanding fees have been settled.Signature*Date* Submit
