Payment for the ELF Psychological Services

Payment for the ELF Psychological Services

Layanan yang dibayarkan hanya berlaku untuk klien yang namanya tertera pada formulir ini. Mohon lakukan pembayaran terpisah untuk klien berbeda. [The paid services would only valid for the client whose name is mentioned below. Please use separate form and payment for more than one client]
Client ID *
Nama Lengkap Klien yang Didaftarkan [Full name of the Appointee] *

First Name Last Name
Email *
example@example.com
Waktu [Appointment Schedule] *

Day Month Year
Date Hour Minutes AM/PM Option

Alamat pengiriman dokumen [Delivery Address]

Nama Jalan [street address]

Blok / nama dan nomor apartemen [unit name/number]

Kota [city] Provinsi [state]

Kode Pos [post code]
Klik di sini untuk melihat daftar harga dan layanan lengkap.

Click here for more detail service and price scheme.
Layanan [Services]
prev next ( X )
Counseling and Psychotherapies $ 33.00

Counselor Group Session
Item subtotal: $ 0.00

Home Visit $ 78.50

Subject

IQ Test $ 36.50

Types Subject
Item subtotal: $ 0.00

E.Q. Test (over 12 y.o.) $ 33.00

Subject

Interest-Aptitude Assessment (Minat Bakat) $ 315.00

Types Subject
Item subtotal: $ 0.00

Clinical Profile Evaluation $ 229.00

Subject

MMPI Evaluation $ 38.00

Subject

Employee Potential Profile $ 58.50

Subject

Test Result Consultation $ 23.50

Subject

Express Reporting $ 13.50

Subject

Shipping Cost $ 5.00

Location Delivery
Item subtotal: $ 0.00

Other $ 20.00

Subtotal $ 0.00 Shipping $ 0.00 Total $ 0.00
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