William G. Austin, Ph.D., Ph.D.
Austin Forensic Psychological Services-North Carolina/dba
Wilmington and Raleigh-Durham-Chapel Hill, North Carolina
Licensed Psychologist, NC #929
Health Services Provider Psychologist (HSP-P)
(970) 846-1157 (voice)
(303) 217-8990 (fax)
Information is absolutely confidential and in accordance with Colorado Revised Statutes, mental health licensing act. (C.R.S. § 12-43-218).
We do not sell, trade, or otherwise transfer to outside parties your personally identifiable information. This does not include trusted third parties who assist us in operating our website, conducting our business, or servicing you so long as those parties agree to keep this information confidential. We may also release your information when we believe release is appropriate to comply with the law, or protect ours or others rights, property or safety.
Your credit card will be charged when you make your pre-payment. Cancellation of appointments must be made 48 hours in advance. If that occurs your credit card will be refunded.
Accepted Payment Methods: Visa, Master Card, American Express, Check/Money Order
CREDIT CARD BILLING FORM
[Fax or e-mail to Dr. Austin]
Down load Credit Card Form for North Carolina
Name on Card:______________________________________________
Type of Card
SVG Code (back of card) ____________Phone Number associated with card:_____________________________________
I authorize Dr. William G. Austin to charge my credit card for psychological services rendered [type initials]
Signature (if faxing):