Thank you for choosing Current Mind Counseling, LLC as your mental health provider. I, the clinician, Jooyoung Kim, LPCC, am committed to providing you with the highest level of quality care. Please take a few minutes to read and sign this form to acknowledge your understanding of Client Financial Responsibility Policies.

Client Financial Responsibilities:

• Clients are ultimately responsible for the payment of all treatment and care.

• Client are required to sign the Credit Card Authorization Form and provide a form of payment (Debit/Credit/Health Saving Account/Other) to be saved on file for payments

• Clients are asked to pay fees at the end of each session; Current Mind Counseling will set it as an auto-pay. 

• Clients are aware that services will be suspended if the payment(s) is due until fully paid. 

• Clients are responsible for any unbalanced fees for late cancellation or no-show fees

• Clients are responsible to communicate with the practice regarding situations including but not limited to credit card information entered is wrong, the transactions are declined; as a result of an outstanding balance, the further sessions will be suspended/discontinued until balances are full paid

• Clients are responsible for fully understanding and familiarizing with Professional Fees (along with No Insurance Policy) and Payment Policies from the Disclosure Statement & Informed Consent Form

• Clients are responsible for fully understanding and familiarizing with Appointment and Cancellation/No-show Policies from the Practice Policies; the fees will be autorun with the credit card information clients submit