Cost of Services - Fee Agreement Form
Payment Responsibility
Court ordered families are assigned payment responsibility by the court. Other referring agencies may indicate in writing who will be responsible for payment. If the referring agency does not indicate who will be responsible for payment, the UVC will assign financial responsibility equally to both parents. Services will not be provided until a fee agreement is signed by both custodial parent and visiting parent, and the initial payment is received. Services may be suspended or terminated due to non-payment of any fee.
Cancellations
All cancellations are non-refundable. The party who cancels will be charged the full visitation fee, regardless of which parent is responsible for visitation costs. Any reschedule from the cancellation must be made least 48 hours of last scheduled appointment or visitation. Rescheduling of a visit needs to be done at least 48 hours prior to visitation. If confirmed contact cannot made with the visit monitor for the reschedule, it will be considered a cancelation and the person canceling will be charged the fee of the visit. For any cancellation, documentation of your reason MUST BE provided.
No Show
A party who fails to arrive for an appointment will be charged the entire amount of the service, regardless of who normally pays. Rescheduling of visits will depend on the Center’s availability and cannot be guaranteed. Two cancellations without notification will result in termination of services and notice will be sent to the referring agency.
Lateness
If a party is going to be late, they must notify their UVC staff member before the meeting start time. A party who arrives at an appointment later than the start time but less than 15 minutes late will be charged a late fee. See table below.
Payment for Visits
All fees will be paid through our payment center. No payments will be accepted in the visitation center. The visit payment and any outstanding fees are required 7 days in advance of a visit. Payment for the next visit is typically made at the time of the current visitation/exchange. We believe this is thoughtful to the children and the other parent in scheduling. It also provides both parents the advance planning necessary to save the money and also to plan for future visits.
Program Services and Fees
1. All financial obligations to Unity Visitation Center MUST BE paid prior to the next visitation or exchange.
2. Billing: We do not engage in billing or providing you with a statement of money owed for visitation. You are paying for services in advance of obtaining them. We will provide you with a printed list of the fees you have paid for the visits and any additional charges you have accrued while working with UVC.
3. Lengthy and frequent phone calls or emails following a visitation will be billed at the consultation fee rate, and you may be referred to therapy, counseling, or mediation, or returned to the court for additional assistance. We are not able to mediate difference between you and the other party.
4. Unity Visitation Center intends to mainly hold our communication with parents through emails. We do TEXT and communicate typically through our cell phones. However, we use email to schedule appointments and to share information.
My Financial Obligation
I agree to pay:
• for all services rendered.
• all penalty fees for services I default on by being late to visitations, late cancellation, no shows, or failure to follow procedures.
• for any damages done by my child due to my failing to properly supervise or parent my child.
• for all requests for documents.
• for all additional court costs and attorney fees.
• any interest charged at the rate of 18% annually for balances overdue to UVC for these services.
I understand that I will be terminated from services for non-payment, and I will only be able to resume visits once I am paid in full. This also may necessitate a larger payment for future visits on my part, paying for 2 or more visits instead of one in advance.
I may withdraw from services with UVC at any point by giving written notice that I no longer wish to participate in supervised visitation and am formally cancelling my visits and withdrawing from their services. Until I do this, I am obligated for all services I have arranged and agreed upon.
Please note: This is considered notice and permission for Unity Visitation Center to send the Withdrawal of Services documentation to any and all parties with whom UVC shares and exchanges information regarding the child.
Adding my INITIALS indicates I understand the fees on these pages and agree to pay them.