Mike LubofskyPsychotherapist and AttorneyPsychotherapy for Individuals and Couples Phone:415-508-6263 Request Appointment Client Payment Information Please provide your payment information below so that we can process your payment on Square following our online session. Name* First Last Address* Street Address City State / Province / Region ZIP / Postal Code Phone*Email* Session FeeSession Fee (per 50 minute session)*Credit Card InformationCredit Card Number* Card Type*American ExpressDiscoverMasterCardVisaExpiration Month*JANFEBMARAPRMAYJUNJULAUGSEPOCTNOVDECExpiration Year*2020202120222023202420252026CVV Number*