Acknowledgment of Services and Fees
I understand that all initial sessions are provided free of charge and are intended solely for informational purposes. Participation in any continued services or programs beyond the initial session is entirely voluntary. It will be billed at a rate of $12 per hour, unless otherwise covered by a formal agreement between Kema Health Services and an affiliated institution. I further understand that the only exception to this fee applies to students currently enrolled at universities that have a direct billing agreement with Kema Health Services, through which program costs may be subsidized or fully covered. I acknowledge that engaging in any recommended services or programs is my personal choice and that Kema Health Services does not guarantee any specific outcomes. I agree that I am responsible for confirming any costs or commitments prior to participation.
The total Program Fee Structure and Payment Policy
I consent to the collection, use, storage, and processing of my personal and, where applicable, health-related information, including any data I submit on behalf of others, for the purpose of evaluating or fulfilling my request made through this form. I understand this will be handled in accordance with the Privacy Notice.
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