CLIENT-CLINICIAN AGREEMENTClient-Clinician Agreement • April 3rd, 2021
CONFIDENTIALITY: All information disclosed within sessions and the written records pertaining to those sessions are confidential and may not be revealed to anyone without your written permission, except where disclosure is required by law.
Client-Clinician AgreementClient-Clinician Agreement • September 8th, 2020
Welcome to Greenleaf Psychological & Support Services (GPSS)! We look forward to working with you toward achieving your goals. GPSS is owned and operated by a Licensed Psychologist, Dr. Barbara Lowe. Our team of qualified Clinicians offers a variety of psychological and behavioral health services designed to meet your specific goals and needs.
DISCLOSURE STATEMENT *** CLIENT-CLINICIAN AGREEMENTClient-Clinician Agreement • July 2nd, 2016
This document reflects the policies of the Clinician, Michael H Gillooly, LCSW-C regarding fees, privacy of records, confidentiality of information, and other administrative issues related to the provision of professional services to the Client.
CLIENT-CLINICIAN AGREEMENTClient-Clinician Agreement • May 11th, 2016
CONFIDENTIALITY: All information disclosed within sessions and the written records pertaining to those sessions are confidential and may not be revealed to anyone without your written permission, except where disclosure is required by law.
Client-Clinician Agreement: TelepsychologyClient-Clinician Agreement • August 22nd, 2019
This Informed Consent for Telepsychology contains important information focusing on doing psychotherapy using the Internet. It is an addendum to the Client-Clinician Agreement in place between existing clients of CPA and their CPA clinician, when telepsychology services are requested. All rights, responsibilities and privileges discussed in the Client-Clinician Agreement remain in force for services conducted using telepsychology. Please read this carefully and let your therapist know if you have any questions. When you and your therapist sign this document, it will represent an agreement between each of you.
Demographic InformationClient-Clinician Agreement • December 20th, 2021
Welcome to Reaching Beyond 4U, LLC! We look forward to working with you toward achieving your goals. GPSS is owned and operated by a LCSWA, HSBC-P, Ernesta D’Angelo. Our team of qualified Clinicians offers a variety of psychological and behavioral health services designed to meet your specific goals and needs. You will find that the following documents cover: 1.) the nature of and course of therapy at GPSS; 2.) client issues and goals; 3.) potential problems and reasonable alternatives to counseling; 4.) confidentiality and its limits; 5.) fees and financial procedures; 6.) limitations about time and access to your clinician, including directions in emergency situations; and 7.) procedures for resolution of disputes and misunderstandings. Our goal and hope is to provide our policies in a reasonably understandable, and yet detailed, format that will empower our precious clients to make informed decisions regarding their treatment. Please take comfort in that your clinician will review t
Monique D. Walker, PhD, MFT 1320 19th Street, NW Suite 200 * Washington, DC 20036Client-Clinician Agreement • October 17th, 2021
CONFIDENTIALITY: All information disclosed within sessions and the written records pertaining to those sessions are confidential and may not be revealed to anyone without your written permission, except where disclosure is required by law.
CLIENT-CLINICIAN AGREEMENTClient-Clinician Agreement • September 7th, 2016
CONFIDENTIALITY: All information disclosed within sessions and the written records per- taining to those sessions are confidential and may not be revealed to anyone without your written permission, except where disclosure is required by law.
Jude Setian-Marston, LCSW-CClient-Clinician Agreement • October 23rd, 2020
CLIENT-CLINICIAN AGREEMENTClient-Clinician Agreement • April 29th, 2016
Confidentiality: All information disclosed within sessions and the written records pertaining to those sessions are confidential and may not be revealed to anyone without your written permission, except where disclosure is required by law.
Insight Counseling Professionals, PLLCClient-Clinician Agreement • February 12th, 2021
