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As a part of GCC’s strict adherence to the ethical code of the American Counseling Association, our staff does keep limited pro bono slots available. We have partnered with a local nonprofit organization to offer additional financial assistance for those who meet the requirements through our Mental Health For All program. In order to be considered, please complete the form. This form must be completed and processed before assistance can be applied to your account. The level of payment assistance will be determined after consultation with our billing department.
Sliding Scale Form
You must make your request in writing using the form provided at this link:
Please complete the link provided. You can send the completed release to email@example.com. Additionally, a release MUST be completed if you are requesting records be sent to a lawyer or another medical provider.
No Show/Cancellation Appeals Form
If you must cancel your appointment less than 48 hours beforehand, due to illness or serious emergency, you may complete the appeals form below to be considered for a reduction (in the form of a partial refund to your account). Please plan ahead and cancel at least 48 hours in advance to avoid the fee. Unless you make other arrangements for payment (with cash or check), we will automatically bill the fee to your credit card on file the day and time of your appointment. If we have made an error in scheduling or you believe you deserve special consideration for a “No-Show / Late Cancelation Fee”, please complete the form below. Your request will be reviewed and you will receive a decision via email.