Hand in Hand Counseling Services

Make a Payment

Here clients can make payments for:

Co-Pay

Cancellation Fee

Other Fees

All payments will be applied to your account and a receipt will be received once payment is cleared.

Enter your amount and press "Pay Now" to submit.

New Client Form

Third Party Referral Form

Clients Name *

Parent/Guardian First Name (if applicable)

Date of Birth *

Phone Number *

Health Insurance *

Email Address *

Brief Summary of Concern

Clients Name *

Date of Birth *

Parent/Guardian *

Phone Number *

Health Insurance *

Date of Discharge (if applicable)

Email Address *

Company/Title *