WEST COUNTY PSYCHOLOGICAL ASSOCIATES
1215 Fern Ridge Parkway, Suite 110
St. Louis, Missouri 63141
Fee Agreement for
Tina Murphy, M.A., L.P.C.
Giving you the best possible service with consideration for your well-being is of utmost importance to us. The following is some information concerning fee schedules and payment procedures.
Payment is due at completion of the session.
A Mastercard or Visa credit card account number and expiration date is required to guarantee payment. The credit card will not be charged as long as there is no balance on the account. If the balance has not been addressed, we will notify you that your credit card will be charged. Please fill in your credit card information on the Billing Information sheet.
Also, we offer Mastercard/Visa services to our clients. If you are interested in charging your visits to either your Mastercard or Visa Account, please fill in the space provided on the Billing Information sheet.
If the fees are covered by insurance, we will be happy to furnish you with an itemized statement for you to submit to your insurance company for reimbursement.
Should you need to cancel an appointment, we require 24 hours notice. Those sessions cancelled without 24 hours notice, other than those cancelled due to emergency, will be charged full fee. In order to cancel, you MUST contact the WCPA office via our office phone number and leave a message for me on my private office voicemail. The office number is 314.275.8599. Cancellations made via email, text, or verbal message to a secretary may still be charged. Thank you for your cooperation.