Statement of Fee Policy

Molly Van Rijssen requests that you read and sign this statement to acknowledge your understanding of the fee policy. Your signature does not bind you to therapy; it does make you responsible for charges incurred.

Fees are payable to at time of service and may be received in cash or credit card payments. The fee for therapy is $180 per (55 min). You will be asked to provide a credit card on file for session charges which will be stored with Square.

Auxiliary services are prorated per 15 min at the same hourly rate as sessions. “Auxiliary services” refers to phone calls, emails, case summaries, records requests, consulting outside providers for client, court evaluations, paperwork for leave or other work-related client needs lasting longer than 15 minutes, or court reports and/or other service requested by the client or entity on behalf of client.

Cancellations: Session times are reserved for you. In the case that you need to cancel or reschedule an appointment, 24 hour notice is required. If given less than 24 hours notice, the full session amount will be charged for the session.