Client Services Agreement. This Agreement is entered into and is governed by the Client Services Agreement, the terms and conditions of which are incorporated herein by reference and remain in effect. To the extent a term or condition in the Client Services Agreement is contrary to a term or condition in this Agreement and the term or condition in this Agreement is required to ensure compliance with HIPAA, the term or condition in this Agreement shall control.
Client Services Agreement. Welcome to my practice. This document (the Agreement) contains important information about my professional services and business policies. THERAPY SERVICES Therapy services offered by Xxxxxx Xxxxxxx, LMFT include evaluation, assessment, consultation, psychotherapy, and intervention. The use of such services varies depending upon particular problems you are experiencing or issues you hope to address. Psychotherapy is not like medical doctor visits. Instead, a very active effort on your part is required for improvement. In order for the psychotherapy to be most successful, you will have to work on things we talk about both during our sessions and at home. My sincere hope is that the therapy I provide will be of help to you. However, as with all medical and psychological treatment, there may risks and benefits. Therapy sometimes may lead to increased emotional distress. Other risks include possible disagreement with my professional opinion. Clients are advised that there are a variety of psychological services or treatment alternatives for any given problem. On the other hand, potential benefits of psychological services may include obtaining a professional opinion and an increased understanding of yourself, which may help resolve your problems and decrease emotional distress. However, there are no guarantees of what you will experience or of results or improvement in any condition. Our first few sessions will involve an evaluation of your needs. By the end of the evaluation, I will be able to offer you some first impressions of what our work will include and, if you enter into psychotherapy, a treatment plan to follow. You should evaluate this information along with your own opinions of whether you feel comfortable working with me. Psychotherapy involves a large commitment of time, money, and energy, so you should be very careful about the therapist you select. If you have questions about my procedures, we should discuss them whenever they arise. If your doubts persist, I will be happy to assist you in locating another mental health professional for a second opinion. Initial: _ 000 X. 0xx Xx, Xxxx X0 Xxxxxx Xxxxx, XX 00000 * (000) 000-0000 * xxxxxxxxxx@xxxxxxxxxxxx.xxx SESSIONS Each appointment hour is a 50 minute session. I normally conduct an evaluation that will last from 2 to 3 sessions. During this time, we can both decide if I am the best person to provide the services that you need in order to meet your treatment goals. If psychotherapy is begun, I wi...
Client Services Agreement. Please read the following pages and feel free to ask questions. As required by Washington State law, I will ask you to acknowledge that you are aware of this information. Feel free to keep this copy or read this statement on my website. Contacting Me Please call me to make an appointment. I can best be reached at 847-477-0355. I check my messages frequently and will return your call most likely the same day, but certainly within 24 hours. If you need to speak to someone urgently and I am not available, please call the Crisis Clinic at (000) 000-0000 or go to the nearest hospital emergency room. Therapy sessions start as scheduled and last 50 minutes. Please call at least 48 hours in advance if you need to reschedule or cancel an appointment. Otherwise, you will be billed the full fee for the session. Please note that if you are using insurance for your therapy and you miss a session, you will be responsible for the full appointment because your insurance will not pay for missed appointments.
Client Services Agreement. Welcome to my practice. This document contains important information about my professional services and business policies. Please read it carefully and note any questions you might have so that we can discuss them at our next meeting. When you sign this document, it will represent an agreement between us.
Client Services Agreement. I acknowledge that I have received a copy of Client Services Agreement for Northwest Speech Therapy/ Spotlight Social Skills along with the Notice of Policies and Practices to Protect the Privacy of Your Health Information. My signature below acknowledges that I have read and understand the information provided, and that I agree to the foregoing terms. Client or Parent Signature Date Consent for treatment, statement of financial responsibility, and release of information: I hereby give my consent for Speech/Language/Social Communication consultation and treatment. I agree to be financially responsible for all charges that accrue from consultation and treatment as well as cancelled appointments in accordance with my therapist’s cancellation policy. I authorize insurance benefits to be paid directly to the therapist, and that the therapist may release any information to the insurance company required for processing any claims. I understand that each therapist in this office is an independent practitioner and no other clinician is involved in the consultation and/or treatment of my dependent. This authorization will remain in effect unless you revoke this Agreement in writing; revocation is not retroactive. Client or Parent Signature Date Consent for use of recordings: Flip video and/or voice recordings may be used to review communication patterns within our sessions. It is a helpful way for clients to observe or listen to themselves and help understand strengths and challenges of their own behaviors. These recordings are only for use in the therapy session. By giving consent, you are acknowledging that you understand that your child may be included.
Client Services Agreement. Welcome. Please read the information below and note any question so we can discuss them. Therapy/Psychotherapy/Counseling/Family Therapy Therapy is hard to describe. Each person experiences it differently. The are many different ways to work on the problems you want to solve. Therapy requires you to actively participate both in the therapy appointment and in the work you will asked to do outside our meeting. Therapy has benefits and risks. Therapy may involve discussing unpleasant experiences. You may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. Therapy has also been shown to have many benefits. Therapy often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress. We don’t know what your experience will be like. By the end of the first few sessions, I will be able to offer you some ideas of what our work together might include going forward. Together we can discuss what a plan to meet your needs might look like. Giving careful consideration to this conversation as well as to your own feelings of comfort with the therapy process, including the financial and time commitment, you should then make a decision about continuing with therapy.
Client Services Agreement. Seller and the Members shall have executed a client services agreement (“Client Services Agreement”) in a form to be mutually agreed on by the parties.
Client Services Agreement. Xxxxxxxxx shall have executed the Client Services Agreement.
Client Services Agreement. By signing your signature below you indicate that you have been given, received, and read the counselor-client services agreement and the notices and forms therein and agree to its terms. Printed Name of a Client (Parent/Guardian must sign on behalf of a minor) Date Signature of a Client (Parent/Guardian must sign if client is a minor) Date Printed Name of Counselor Providing Services at North Star Date Signature of Counselor Providing Services at North Star Date continued from previous page NSCC Information North Star Counseling and Consulting, LLC. Main Office Contact: 000.000.0000 Main Office Fax Contact: 000.000.0000 Main Office Email: xxxx@xxxxxxxxxxx.xxx Mailing Address: North Star Counseling and Consulting, LLC. P.O. Box # 1753 Versailles, KY 40383
