Free therapy pricing and service options form — tiers, sliding-scale bands and add-ons clients self-select, with payment preference recorded.
Quick answer
Free therapy pricing and service options form — tiers, sliding-scale bands and add-ons clients self-select, with payment preference recorded.
Disclaimer: this template presents practice service options; it does not process payments. Pricing, refund and consumer-disclosure rules must follow your local requirements.
Content note: example tiers and bands are illustrative — replace them with your actual rates before use.
The fee conversation is where prospective clients freeze and dropout quietly. This pricing form lays tiers, sliding-scale bands and add-ons side by side so clients self-select what fits in three minutes, capture payment preference (collection stays with your own provider) and generate one readable summary — turning price from a wall into a plan.
Fillable sample form preview (live once the app is published).
The tiers, session counts and payment preferences to choose.
Session options described side by side.
Income-band or hardship choices with dignity.
What extras exist and what they include.
Chosen options combine into one readable quote.
From copy to a chosen pricing plan in four steps.
Import the pricing form into your workspace — free.
Tiers, scale bands and add-ons you offer.
Three minutes replaces the fee awkwardness.
The summary anchors the first-appointment agreement.
Who uses it — practices presenting fees before intake.
Fee conversations without the freeze or the drift.
Scale bands collected consistently.
One pricing story across the roster.
What makes this pricing form transparent for clients.
A preview of the real fields — replace rates with your own.
