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Service:PHONE Consultation (20 Minute) add another, change
Staff: Diane Provo
Date/time:Fri, May 24 at 11:40 AM (PDT) change

Thank you for joining Full Slate! We would like to take a minute to review the policies of Diane's practice:

  • All new clients must have at least one current credit card on file with us (we suggest two). If you have not already done so please fill out the secure payment form found at the Client Center on Diane's website: http://www.dianeprovo.com/Client-Center.html. 

The fee schedule is as follows (effective 3/15/22): 
  • VENMO Rate $240/hour  Venmo Name:  @DianeProvoAppointment   (Please include your appt. date, duration of the appt. and type of appt. (zoom, phone, etc..)
  • Credit Card/Debit: $250/hour
  • Standard / Billed Rate:  $270/hour  
  • Travel Time:  $160/hour (minimum travel time billed is 30 minutes round trip). 

CANCELLATION POLICY: 
A 24 hour notice is required to cancel Office, Zoom or Phone appointments. For off-site consultations (i.e.: Observations, Home Visits, School Meetings, etc...) we require a 72 hour cancellation notice. In the event, that you fail to notify us in the appropriate amount of time, the full fee for the scheduled appointment will be billed to your credit card.

  • Generally, we maintain a waiting list for new clients but will make every attempt to accommodate your appointment request.
  • Not all of the following information is required, but highly recommended for new clients to provide:

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First name*
Last name*
Email*
Phone*
Street address*
City, state, zip*
Name of Child*
Child's Date Of Birth*
Name of School*
Grade*
Parent 1 Cell Phone*
Parent 2 Cell Phone*
Parent 1 Home Phone
Parent 2 Home Phone
Parent 1 Email*
Parent 2 Email*
Referred By
Doctor or Other Professional, Specialty
Purpose of Visit*
Please let us know your concerns and reason for seeing Diane. (Educational Concern, Behavioral, etc...)
* required field