Group Therapy/Class Financial Form

Thank you for completing this form. If you have any questions, please call our office at (970) 413-8998.
We will reach out if anything else is needed.

Group Therapy and Class Financial Authorization

Payment method for group therapy or classes

  • MM slash DD slash YYYY
  • You can write something like: "Premarital Feb 2023" or " "teen girls group"
  • If choosing cash or check, we will still need a card on file in case of late cancellations, no-shows, or lack of payment. Thank you.
  • This field is for validation purposes and should be left unchanged.