Online Payment

Danielsen Institute – Online Payments

Dear Clients,

In order to credit your payment appropriately, please provide the information below so that we know for which service(s) you are paying. You do not need to enter information into every field, but please tell us enough to reflect your payment properly in your account. Thank you!

Name of Payer*
First Last
Email*
Payment Amount in USD $*
Client Name (if different than Payer)
First Last
Danielsen Account Number

Your account number is listed on all statements from Danielsen. Please enter 0000 if the account number is not known.
Clinician Name
First Last
Date of Service
Type of Service

Individual
Couples/Family
Medication Management
Group
Testing

Refund Policy: Overpayments will be reviewed and refunded as soon as possible.

Please verify that the information is correct above and then press Submit and you will proceed to the secure Nelnet Payment form where you can enter your credit card information.