Leap of Language Inc.

 

37171 Sycamore Street Apt. 633, Newark, CA 94560

stcin001@gmail.com

205-534-4330

 

Payment Policy and Fee Schedule

Thank you for choosing Leap of Language Inc. to serve you. We are committed to providing you with the highest quality care. Please know that the timely payment of your bill is an integral part of our service and as such, this payment policy is an agreement between you and Leap of Language Inc. for payment of services provided. By signing this policy, you are agreeing to pay for services provided to you or your family member. As a client of Leap of Language Inc. you are required to carefully review and sign our payment policy.

Please read the following information carefully

 

All therapy fees (including session fees and/or co-pays, if applicable) are due:

We accept the following payment methods at this time:

 

  • Debit Card 

  • Credit Card

  • Check 

  • Cash

  • HSA

  • FSA

Checks should be made payable to Leap of Language, Inc.

 

We will provide you with an invoice outlining the services rendered and the amount charged.

Please read and check all boxes to acknowledge understanding and then sign below:

Signature ofClient or Legal Representative

Private Practitioner/Witness

© 2020 by PIMM-USA. Proudly created for Leap Of Language Inc.

Speech Therapy in Newark | Language Therapy in Newark | Pediatrics 94560

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