Sliding Scale

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By signing the following document electronically, it is to be the legally binding equivalent of your individual handwritten signature. 

 

SLIDING SCALE DISCOUNT APPLICATION

In order to receive the sliding scale discount for office visits, you must document all household income. Documentation may be paycheck stub, income tax form, tax return, bank statements, or a letter from an employer. Forms of income include earnings from jobs, unemployment, disability, welfare, social security, interest income, gifts and income from property. Please report any changes to income at your next visit. The following must be completed prior to your first session in order to receive a discount.

Please list family members living in the same household, including children under the age of 18.

I hereby certify under Penalty of Perjury, that all of the information provided on this application is true and accurate, to the best of my knowledge. I understand that supplying false information on this form is a fraudulent act, under the laws of the State of California, which could result in civil or criminal penalties including fines and/or imprisonment.

Employment

If you are a licensed counselor, a counselor intern or interested in individual or group supervision and would like to join our team, please contact us.

Meredith Akin-Ivey, is a Licensed Professional Counselor-Supervisor and a Registered Play Therapist- Supervisor.  Please E-mail or call her for more details.

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Get in touch

Compassion Counseling
2214 Michigan Ave
Suite F
Arlington, Texas
76013

Phone: (817) 723-1210

Fax: (866) 776-5116

info@compassioncounseling.us

Our Specialities

At Compassion, our counselors have experience counseling a variety of issues including but not limited to: adoption, anxiety, abuse, body image, depression, couples, faith, families, grief, play therapy, parenting, teens, trauma, christian sex therapy, and self-esteem. Please call our office for more information regarding each counselor's specialty.