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SLIDING SCALE FEES
We believe money should never stand in the way of good counseling. We also believe that clients are adults and are well aware of what they can afford to pay. So we never request proof of income. We simply ask that you refer to the chart below. These are suggestions for what you might pay depending on family income and size. We trust and honor your decision.

SUGGESTED FEE SCALE
Household Size: Adults & Dependents

sliding scale fees border

Whatever fee you choose is paid at the time of service. If you fail to show for a scheduled appointment or do not call to cancel 24 hours before a scheduled appointment (386.492.6938), we ask that you pay the full agreed upon fee.

The standard fixed rate for assessments for any third party (Court System, Lawyers, etc.) will be $80 per hour.

The Rate I Choose _________________

 

Client Signature _______________________________ Date ___________________

Counselor/Therapist __________________________ Date ___________________

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  0 to $30,000

$35

$35

$35

  $30,001 to $40,000

$40

$35

$35

  $40,001 to $50,000

$50

$45

$40

  $50,001 to $60,000

$60

$55

$50

  $60,001 to $70,000

$70

$65

$60

  $70,001 to $80,000

$80

$70

$60

  $80,001 to $90,000

$90

$80

$70

  $90,001 to $100,000

$100

$90

$80

  $100,001 and Up

$110

$100

$90

 

Household Yearly Income

1 - 2

3 - 4

5 +

386.492.6938
4639 Clyde Morris Boulevard, Unit 107 • Port Orange, FL 32129

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