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Credit Card Authorization

 
 
By using Auto Debit offered through Impact Family Inc., your counseling will be automatically deducted from an account you designate on the payment due date specified in your invoice or other written agreement.

Please make sure to fill out all fields and read the form carefully. If this form is not completed or is filled out incorrectly, it will be disregarded.

By using Auto Debit offered through Impact Family Inc., your counseling will be automatically deducted from an account you designate on the payment due date specified in your invoice or other written agreement.

Please make sure to fill out all fields and read the form carefully. If this form is not completed or is filled out incorrectly, it will be disregarded.

Regular Sessions are $65.00 - $85.00 suggested contribution. All donations are tax-deductible (See Tax Exempt Certificate).   

Counselors have the same contribution rates. If you are experiencing economic hardship, please fill out a Counseling Scholarship Request to see how we can assist you.

Suppose you cancel or reschedule an appointment before the 72-hour deadline by clicking the cancellation or reschedule link in the email we send you. In that case, we will issue a refund or allow a reschedule.

If you do not receive a refund, please submit a refund request form.  Suppose you don't attend your session apart from a doctor verified medical emergency.

In that case, we will not be able to refund the contribution due to the counselor's time or other clients who could have benefited from that session. Thank you!