TREATMENT PLANNING AND EVALUATION. Since Look Inside Counseling is not a 24-hour crisis-intervention agency, in case of an emergency, you may call the numbers on the accompanying EMERGENCY NUMBERS sheet, or you may call 911 or go to the nearest hospital emergency room. Your therapist can approximate length of treatment and probable results; however, as response differs on an individual basis, guarantees cannot be made as to treatment outcome. If one of our therapists cannot provide the services you need, s/he can offer you referral information. Periodically, client and therapist will assess progress toward treatment goals. It can be mutually beneficial if termination is discussed in advance.
TREATMENT PLANNING AND EVALUATION. Since Transformative Counseling is not a 24-hour crisis-intervention agency, in case of an emergency, you may call the numbers on the accompanying EMERGENCY NUMBERS sheet, or you may call 911 or go to the nearest hospital emergency room. Your therapist can approximate length of treatment and probable results; however, as response differs on an individual basis, guarantees cannot be made as to treatment outcome. If we cannot provide the services you need, your therapist will offer you referral information. Periodically, client and therapist will assess progress toward treatment goals. It can be mutually beneficial if termination is discussed in advance. * * * * * * * * * * I have received a copy of the NOTICE OF PRIVACY PRACTICES. Client initials I have been given a copy of this CLIENT-THERAPIST AGREEMENT and a list of EMERGENCY NUMBERS. I have read the preceding information and understand my/my child’s rights as a client. I consent to treatment at Olive Tree Counseling, LLC. Adult Signature Date Teen Signature (ages 15-18) Date Therapist Signature Date Therapist Signature Date FOR FAMILIES: Name(s) of Client(s) if minors I attest that I am authorized to give permission for my child(ren) to have counseling at Olive Tree Counseling, LLC. Parent/Guardian Signature (of children age 14 and under) Date Parent/Guardian Signature (of children age 14 and under) Date
TREATMENT PLANNING AND EVALUATION. Since I am not a 24-hour crisis-intervention therapist, in case of an emergency, you may call the numbers on the accompanying EMERGENCY NUMBERS sheet, you may call 911 or go to the nearest hospital emergency room. As your therapist, I can approximate length of treatment; however, as response differs on an individual basis, guarantees cannot be made as to treatment outcome. If I cannot provide the services you need, I will be happy to offer you referral information that will be a better fit to you. Periodically, client and therapist will assess progress toward treatment goals. It can be mutually beneficial if termination is discussed in advance. CANCELLATIONS: In the case that you need to cancel or reschedule an appointment, 24-hour advance notice is required. With less than 24 hours notice, you will be charged the full amount for the session.
