Credit Card Authorization

This is a contribution for a 50-minute session at a $65.00 suggested rate. Written permission is needed by your counselor to make a contribution here to secure the counseling date requested. 

All donations are tax-deductible (See Tax Exempt Certificate). 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.

If you are experiencing economic hardship, please fill out a Counseling Scholarship Request to see how we can assist you.