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Billing Forms
Go Here For The Premarital Support Billing Form. 

Marriage Support
Provider Billing Form

Kingdom Family Ministry Marriage Support Program 

Date
Month
Day
Year

Client Information

Counseling Session Length (Note: KFM will only pay for one hour of counseling)
Were husband and wife both in attendance?
What Counseling Session Was This?
Do you plan to continue counseling with the client?
I understand I must receive prior approval for sessions 7, 8, & 9. One time approval for all three session can be requested by completing the following evaluation form after the sixth session. www.kingdomfamilyministry.org/providerevaluationform
Yes
No

Payment Information

Preferred Payment Method
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Has any of the billing information changed? If so, indicate the change below.

Thank you for all you do to build kingdom  marriages!

Pre-Marital Support
Provider Billing Form

Kingdom Family Ministry Marriage Support Program

Date
Month
Day
Year

Client Information

Counseling Session Length (Note: KFM will only pay for one hour of counseling)
Were Both Clients In Attendance?
What Counseling Session Was This?
Do You Plan To Continue Counseling With The Client?

Payment Information

Premarital counseling is $75/ per session for six sessions.

Preferred Payment Method
Has any of the billing information changed? If so, indicate the change below.
Payment Address
Zelle Account Information
Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Thank you for all you do to build kingdom marriages!

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