Forms

Insurance and Payment

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I understand that the charges for the initial session is $280.00. Additional sessions are $150.00.

I understand that a current credit card will be kept on file and charged 24 hours prior to the appointment.

GMHR accepts cash, personal checks Visa and Mastercard. We do not accept two party checks. Returned checks marked “Insufficient Funds” will result in processing fees from the bank and from GMHR.

All fields that have a “*” are required. Contact us with any questions regarding the form.

Have you read over the terms and do you accept them?*