Follow the steps to fill out the Reduced Fee Agreement online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in your name in the 'Client Name' section. This is essential for identifying your request.
3. In the 'Reason for Request' section, provide a brief explanation of why you are seeking a reduced fee. This helps tailor your payment arrangement to your needs.
4. Indicate the number of dependents you have in the field provided. This information may affect your eligibility for reduced fees.
5. Enter your gross annual household income in the designated box. This figure is crucial as it determines what fees you qualify for.
6. Review the standard psychotherapy fees listed to understand the pricing structure. This will give you context for your reduced fee request.
7. Choose your agreed-to reduced fee amount by completing the relevant fields for individual sessions and group therapy, based on your income.
8. After filling in the required details, review all entries for accuracy.
9. Save your changes, download the document, print it for your records, or share it as needed.

Complete your Reduced Fee Agreement online today to ensure accessible therapy services.