Payments

Thank you for using our online form to pay for Telehealth services. This is a secure system, and your payment information is safe.

Please select the therapist or prescriber that you met with for your session and provide the amount you wish to have charged.

We now offer payment plans through AfterPay. Read More

Patient Information
Name*
First Last
Address*
Street Address City State ZIP Code
Phone*
Email*
Session Payment Information
Therapist/Prescriber*
Select the Therapist/Subscriber being paid.
Amount to Pay*
Total
$0.00
Credit Card Information

Credit Card

Cardholder Name

Card Details

Consent*
By submitting this form, I authorize Benhaven Counseling 2, LLC to charge my credit card for the Total amount specified above.

Now Offering Payment Plans through AfterPay

If you have gotten behind due to hardship or a high deductible, Benhaven Counseling 2 LLC Is pleased to offer After Pay – This is a Buy Now Pay Later Option (BNPL).

This will allow you to break your balance into 4 payments over the course of 6 weeks and then AfterPay will automatically collect the payments from your provided credit or debit card.

During the checkout process you will be directed to the AfterPay site or App to use the application process. You must complete this process from the link below, not from this invoice.

Schedule a Payment Plan Now

Payments

Patient Information

Session Payment Information

Credit Card Information

Now Offering Payment Plans through AfterPay