top of page
Please print, fill out & submit the Credit Card Authorization form for us to retain your payment information on file. You will need to choose your credit card type, your payment frequency (one time payment or recurring) and the day of the week/month you wish to be auto-billed.
Credit Card
Authorization
Mental Health Wellness

Call us today at 1.614.785.1115

Mental Health Wellness
  • Facebook Social Icon

1035 Proprietors Road • Worthington, OH 43085

Office phone: 614-785-1115  •  Office fax: 614-785-0095

© 2024 by Central Ohio Counseling, Inc.

bottom of page