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Teletherapy available upon request.

Credit Card Authorization

I give my permission for O’Leary Counseling to keep the following card on file for the purpose of charging counseling services as outlined in my client services contract.

You will be informed before a charge is made and a receipt will be given upon request.

Reason and amount to be charged: Deductibles and copays (if applicable). Late Cancellation or No Show $61.00 ($60.00 cancellation fee + $1.00 CC processing fee). Late Cancellation for a group session will incur a charge of $41.00.

By signing this form I acknowledge the charges described hereon and assume full responsibility for said charges and agree to honor and abide by the terms of payment.