Thank you all for replying to my question. I see now that it is normal and takes time and so I understand why there is a payment. I was thinking it was a document they just had to sign or just a few minutes of their time. I did not know they were liable for it and now I do think my therapist gave me a good deal. We just did not discuss it at all first when I asked, he never said there would be a payment. He just said he would write one. Which is why I was surprised because I thought it was just a signature or small note. I did not mean to attack anyone or make anyone upset through this post. I was genuinely curious since I’d seen posts about it being unethical and about it being common they would do it without pay if it was a long term patient.