Informed Consent And Service AgreementConsent and Service Agreement • July 17th, 2019
Welcome to Safe Connections. This document contains important information about your rights, our services and guidelines. A copy of this document will be provided to you at the end of your appointment.
INFORMED CONSENT AND SERVICE AGREEMENT FOR THERAPEUTIC SERVICESConsent and Service Agreement • April 19th, 2016
Psychotherapy is a professional relationship between a client and a therapist that involves both risks and benefits. Risks may include experiencing uncomfortable feelings, such as anxiety, depression, guilt, frustration, anger, loneliness, and helplessness because psychotherapy often involves discussing some difficult aspects of your life. Research has revealed, however, that psychotherapy can yield long term benefits. Therapy often leads to a significant reduction in distress and mental health symptoms while improving quality of life, relationships, self- awareness, insight, and improved problem solving skills. To yield the best results, it is important for you to be active in your treatment plan goals, participation, and follow through with practices outside of session. Both the client and the therapist have the right to terminate the therapeutic relationship at any time. Should therapist initiated termination occur, the therapist will provide a list of referrals if appropriate.
Energy Healing Consent and Service AgreementConsent and Service Agreement • December 10th, 2023
Service Agreement: Energy healing can be used as a support to a self-managed wellness program. I am a New York State licensed and registered Occupational Therapist. However, when serving you as an alternative energy healer, my role is non-clinical and should be understood as such. I will not be evaluating and treating you as an Occupational Therapist during our work together. There is currently no licensure for energy healing. I am not a licensed physician or psychologist who will treat, diagnose, cure, or prevent any type of medical condition or psychological disorder. If at any time, you experience a serious medical or psychological condition be sure to contact a licensed physician or psychologist.
Consent and Service AgreementConsent and Service Agreement • August 7th, 2024
Welcome to your first session at my practice. This document contains important information about my professional services and business policies. It also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and patient rights about the use and disclosure of your Protected Health Information (PHI) for the purposes of treatment, payment, and health care operations. Please review carefully. When you sign this document, it will also represent an agreement between us. We can discuss any questions you have when you sign them or at any time in the future.
INFORMED CONSENT AND SERVICE AGREEMENTConsent and Service Agreement • July 6th, 2020
Welcome to my practice. This document contains important information about my professional services and business policies. It also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and patient rights about the use and disclosure of your Protected Health Information (PHI) for the purposes of treatment, payment, and health care operations. Although these documents are long and sometimes complex, it is very important that you understand them. When you sign this document, it will also represent an agreement between us. We can discuss any questions you have when you sign them or at any time in the future.
Informed Consent and Service Agreement for Parent Coordination ServicesConsent and Service Agreement • May 29th, 2008
Overview. The primary goal of parent coordination is to provide parents with a forum for resolving child-related disputes outside of the courtroom. The duties of a parent coordinator include providing parents with problem solving and conflict management services, monitoring compliance with court orders, and providing parents, attorneys, and the court with recommendations for new or modified parenting time provisions, as necessary. This process differs from both therapy and mediation: there is no therapist/client privilege, the process is not confidential, and insurance companies generally do not offer reimbursement for parent coordination. In addition, the scope of parent coordination is limited to matters concerning your child. It is expected that both parents will maintain a respectful tone during discussions, make good faith efforts toward cooperation, and prioritize the interests of the child over other competing concerns.
Informed Consent and Service AgreementConsent and Service Agreement • April 11th, 2017
Welcome to Counseling by Cheryl Moses, LPC. Through strictly confidential interviews, either individual, joint, family or group, you are helped to understand the cause of a problem and methods of dealing with that problem. My goal is to help you understand and make better use of your own strengths and to maintain a meaningful lifestyle. The ultimate goal of therapy is to improve your lifestyle. Through therapy, you may begin to view circumstances and options differently than you did in the past. However, it is important to understand that the process takes time and may make things seem worse before they seem better. If there are any questions about the services you are encouraged to discuss them with your counselor. The relationship between you and your counselor is voluntary. You have the right to terminate therapy if you feel it is in your best interest.
CONSENT AND SERVICE AGREEMENTConsent and Service Agreement • July 12th, 2022
Qualifications: I am a Licensed Professional Counselor and an Licensed Chemical Dependency Counselor in Texas. I also have a Ph.D in Counselor Education and Supervision for the University of Texas San Antonio TX. My formal education prepares me to counsel individual adolescents and adults, groups, and families. My area of focus is in addiction and recovery services.
