• Client Information

  • Emergency Contact

    In the event of an emergency, whom should we contact?
  • Insurance and Signature

  • Max. file size: 64 MB.
    Please upload a picture of the card front.
  • Max. file size: 64 MB.
    Please upload a picture of the card back.
  • Counseling Fee Policy

    The intake session fee is $155.The general counseling fee is $130 per session hour. Payment is expected at the time of service.
  • The Franciscan Life Process Center accepts most insurance. If you have insurance, check with the counselor to see if the FLPC is an in-network provider and if pre-authorization is necessary. If you would like help in submitting bills to your insurance carrier, please let us know. If you fail to inform us that your insurance has changed and/or your session payment is not covered for this or any other reason, you will be responsible for full payment of the session. Preferred payment methods include cash, personal check or credit card. Your appointment time is reserved for you. The Franciscan Life Process Center policy dictates that any missed appointments, which are non-emergencies, will be charged to you according to the following schedule as insurance policies do not pay for missed or canceled appointments.
  • • Broken appointments: (no shows) full session fee ($130.00) is required
  • • Cancellations with less than 24 hour notice: (non-emergencies) 50% of session fee ($65.00) is required
  • • Delinquent accounts may be referred to a collection agency.
  • • Emergency cancellations: no charge