Intake Payment Form

Thank you for choosing Anger Management 818!

Client's First Name: *

Client's Last Name: *

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Please choose the item you would like to pay for: * 🛈

Anger Assessment (Part 1 of Intake) ($70) - Select this option if you plan to attend groups.

(Offered virtually only and not in person) Intake and Individual Session 1 with Certified Anger Management Counselor ($100)

Intake and partial individual session with Associate ($150)

Intake and partial individual session with Licensed ($250)

Intake and partial individual sessions with the Director of Anger Management 818 ($350)

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PLEASE NOTE:

Even if you do not have a PayPal account, click the "Checkout With PayPal" option on the payment screen and the follow directions given for "Don't have a PayPal account".

Thank You.

*********READ THE FOLLOWING INSTRUCTIONS BEFORE SUBMITTING PAYMENT*********

After submitting your intake payment on the PayPal payment system using a credit or debit card, click the "RETURN TO MERCHANT WEBSITE" button. After clicking the RETURN TO MERCHANT WEBSITE button, you will be redirected back to our website to complete the INTAKE REGISTRATION FORM.

Completing the INTAKE REGISTRATION FORM IS REQUIRED in order to complete your Anger Management class registration and enrollment. The intake form takes about 10-15 minutes to complete. Once the form has been completed and submitted, an Anger Management Facilitator will contact you to schedule a time/day for an INTAKE INTERVIEW.

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