Termination of Therapy. I reserve the right to terminate therapy at my discretion. Reasons for termination include, but are not limited to, untimely payment of fees, failure to comply with treatment recommendations, conflicts of interest, failure to participate in therapy, client needs are outside of my scope of competence or practice, or client is not making adequate progress in therapy. Client has the right to terminate therapy at his/her discretion. Upon either party’s decision to terminate therapy, I will generally recommend that client participate in at least one, or possibly more, termination sessions. These sessions are intended to facilitate a positive termination experience and give both parties an opportunity to reflect on the work that has been done. I will also attempt to ensure a smooth transition to another therapist by offering referrals to client. Acknowledgment By signing below, client acknowledges that he/she has reviewed and fully understands the terms and conditions of this Agreement. Client has received a copy of the office Privacy Policy. Client has discussed such terms and conditions with Therapist, and has had any questions with regard to its terms and conditions answered to client’s satisfaction. Client agrees to abide by the terms and conditions of this Agreement and consents to participate in psychotherapy with Therapist. Moreover, client agrees to hold Therapist free and harmless from any claims, demands, or suits for damages from any injury or complications whatsoever, save negligence, that may result from such treatment. Client Name (please print) Date
Appears in 2 contracts
Samples: vinderlallian.com, vinderlallian.com
Termination of Therapy. I reserve the right to terminate therapy at my discretion. Reasons for termination include, but are not limited to, untimely payment of fees, failure to comply with treatment recommendations, conflicts of interest, failure to participate in therapy, client needs are outside of my scope of competence or practice, or client is not making adequate progress in therapy. Client has the right to terminate therapy at his/her discretion. Upon either party’s decision to terminate therapy, I will generally recommend that client participate in at least one, or possibly more, termination sessions. These sessions are intended to facilitate a positive termination experience and give both parties an opportunity to reflect on the work that has been done. I will also attempt to ensure a smooth transition to another therapist by offering referrals to client. Acknowledgment By signing below, client acknowledges that he/she has reviewed and fully understands the terms and conditions of this Agreement. Client has received a copy of the office Privacy Policy. Client has discussed such terms and conditions with Therapist, and has had any questions with regard to its terms and conditions answered to client’s satisfaction. Client agrees to abide by the terms and conditions of this Agreement and consents to participate in psychotherapy with Therapist. Moreover, client agrees to hold Therapist free and harmless from any claims, demands, or suits for damages from any injury or complications whatsoever, save negligence, that may result from such treatment. Client or Client representative acknowledges having received a copy of the Notice of Privacy Practices. Client Name (please print) Date Signature of Representative Date (or authorized representative and relationship to client) Signature of Representative Date
Appears in 2 contracts
Samples: vinderlallian.com, vinderlallian.com
Termination of Therapy. I reserve the right to terminate therapy at my discretion. Reasons for termination include, but are not limited to, untimely payment of fees, failure to comply with treatment recommendations, conflicts of interest, failure to participate in therapy, client needs are outside of my scope of competence or practice, or client is not making adequate progress in therapy. Client has the right to terminate therapy at his/her discretion. Upon either party’s decision to terminate therapy, I will generally recommend that client participate in at least one, or possibly more, termination sessions. These sessions are intended to facilitate a positive termination experience and give both parties an opportunity to reflect on the work that has been done. I will also attempt to ensure a smooth transition to another therapist by offering referrals to client. Acknowledgment By signing below, client acknowledges that he/she has reviewed and fully understands the terms and conditions of this Agreement. Client has received a copy of the office Privacy Policy. Client has discussed such terms and conditions with Therapist, and has had any questions with regard to its terms and conditions answered to client’s satisfaction. Client agrees to abide by the terms and conditions of this Agreement and consents to participate in psychotherapy with Therapist. Moreover, client agrees to hold Therapist free and harmless from any claims, demands, or suits for damages from any injury or complications whatsoever, save negligence, that may result from such treatment. Client or client representative acknowledges having received a copy of the Privacy Policy. Patient Name (please print) Date Signature of Patient (if patient is 12 or older) Date
Appears in 1 contract
Samples: www.lanagarvin.com
Termination of Therapy. I reserve Therapist reserves the right to terminate therapy at my his/her discretion. Reasons for termination include, but are not limited to, untimely payment of fees, failure to comply with treatment recommendations, conflicts of interest, failure to participate in therapy, client Client needs are outside of my Therapist’s scope of competence or practice, or client Client is not making adequate progress in therapy. Client has the right to terminate therapy at his/her discretion. Upon either party’s decision to terminate therapy, I Therapist will generally recommend that client Client participate in at least one, or possibly more, one termination sessionssession. These sessions are intended to facilitate a positive termination experience and give both parties an opportunity to reflect on appreicate the work that has been done. I Therapist will also attempt to ensure a smooth transition to another therapist by offering referrals to clientClient. Acknowledgment Acknowledgement By signing below, client Client acknowledges that he/she has reviewed and fully understands the terms and conditions of this Agreement. Client has received a copy of the office Privacy Policy. Client has discussed such terms and conditions with Therapist, and has had any questions with regard to its terms and conditions answered to clientClient’s satisfaction. Client agrees to abide by the terms and conditions of this Agreement and consents to participate in psychotherapy with Therapist. Moreover, client Client agrees to hold Therapist free and harmless from any claims, demands, or suits for damages from any injury or complications whatsoever, save negligence, that may result from such treatment. Client Name (please print) Signature of Client (or authorized representative) Date
Appears in 1 contract
Samples: terrijclarke.com
Termination of Therapy. I reserve the right to terminate therapy at my discretion. Reasons for termination include, but are not limited to, untimely payment of fees, failure to comply with treatment recommendations, conflicts of interest, failure to participate in therapy, client needs are outside of my scope of competence or practice, or client is not making adequate progress in therapy. Client has the right to terminate therapy at his/her discretion. Upon either party’s decision to terminate therapy, I will generally recommend that client participate in at least one, or possibly more, termination sessions. These sessions are intended to facilitate a positive termination experience and give both parties an opportunity to reflect on the work that has been done. I will also attempt to ensure a smooth transition to another therapist by offering referrals to client. Acknowledgment By signing below, client acknowledges that he/she has reviewed and fully understands the terms and conditions of this Agreement. Client has received a copy of the office Privacy Policy. Client has discussed such terms and conditions with Therapist, and has had any questions with regard to its terms and conditions answered to client’s satisfaction. Client agrees to abide by the terms and conditions of this Agreement and consents to participate in psychotherapy with Therapist. Moreover, client agrees to hold Therapist free and harmless from any claims, demands, or suits for damages from any injury or complications whatsoever, save negligence, that may result from such treatment. Client or client representative acknowledges having received a copy of the Privacy Policy. Client Name (please print) Date Client Name (please print) Date
Appears in 1 contract
Samples: www.lanagarvin.com