Forms | Hall Counseling

top of page

Home
Our Space
Our Team
Our Services
Events
- RelateStrong
Resources
Blog
Book Appointment
More

Use tab to navigate through the menu items.

Flowers

FORMS

First Visit Forms

Informed Consent - Jennifer Hall

TeleCounseling Informed Consent

Credit Card Authorization Agreement

Client Name

Guarantor Name

Effective Date of Agreement

I authorize Hall Counseling to charge the following credit/debit card for all counseling/psychological/educational services for the above mentioned client. This agreement may be revoked at any time by written request.

Name (as appears on card)

Card Number

Expiration Date

C V V

Billing Address

Zip Code

Guarantor Signature

Card won't be automatically charged. Hall Counseling will manually submit. Thanks for submitting!

OFFICE

1418 Heights Blvd
Houston, TX 77008

SUBSCRIBE TO OUR NEWSLETTER!

HOURS

Hours vary for each therapist,

hallfamilycounseling@gmail.com

FOLLOW US

bottom of page