By submitting this form I agree to pay your fee per clinical therapy session at the time of the session . This does not apply to free consultations. I understand that you do not accept FTPOS or Credit Card payments but I may pay by cheque, cash, Paypal, or Bank Transfer. I agree to pay $100 cancellation fee if cancellation is not made within 24 hours of an appointment; I understand that no warranties are provided that my Health Insurance Provider will rebate and it is my responsibility to claim for any rebate; I give you permission to email, telephone or SMS text me.