Online Debit or Credit Card for your counseling session

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Option 1 - Direct payment

Once you have made your payment you will have the option to receive a receipt by email or text. Kindly forward a copy of the receipt to your clinician via email so that they are able to correctly update your patient payment records. Click on the “Direct Payments” icon to process your payment.

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Option 2 - Use this link if you have a paypal login account

If you have a PayPal login account you can use this link to pay for your counseling session. Your clinician will receive an automatic alert regarding the payment. There is NO NEED to forward a copy of your receipt to your clinician. Click on the “PayPal” icon to process your payment.

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Option 3 - Use this option to pay if you are using a computer

This option should be used only if you are making your payment via computer. Your clinician will receive an automatic alert regarding the payment so there is NO NEED to forward a copy of your receipt to your clinician. Please complete the form below to process your payment.

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Enter your full name: This field is required.
What is your counseling session date: (mm/dd/yyyy) This field is required. Date Format: mm/dd/yyyy
Enter your email: This field is required. You must enter an email address
Please select your counselor: This field is required!	Ayako, Lawrence Maria Massiani Marquez Cindy, Gordon Francine, Melanson-Rose Lucy, Buxbaum Lovern, Moseley Saira, Qureshi Raoul, Robert Todd Cassidy Maria Neves Robert Gatabazi Christine Williams Constance Wynne Arthur Erskine Elizabeth Dwyer Danielle Flint Lisa Bibuld Kevin Hathaway Rachel Taggart Adrienne De Vaughn Kenna Sulivan Renee Desaulniers EmpowermentCPC Office
Amount to Charge	Numeric Only Please  This field is required
Card Type:	MasterCard Visa American Express Discover Solo Switch  This field is required
Card Number:	Please enter numbers only  This field is required
Name on the card:	This field is required
Expiration:	01 02 03 04 05 06 07 08 09 10 11 12 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033  Month required Year required
Card Security Code:	Please enter numbers only   This field is required    (3 or 4 digit code on the back of your card)