COUNSELING SERVICES AGREEMENTCounseling Services Agreement • January 30th, 2023
Welcome to my practice. Psychotherapy is not easily described in general statements. It varies depending upon the personalities of the therapist and patient, and the particular problems you are experiencing. There are many different methods I may use to deal with the problem that you hope to address. Psychotherapy is not like a medical visit. Instead, it calls for a very active effort on your part. In order for the therapy to be most successful, you will have to work on things we talk about both during our session and at home.
Encourage Counseling ServicesCounseling Services Agreement • November 5th, 2017
Counseling Services AgreementCounseling Services Agreement • April 15th, 2019
This document answers questions which clients often ask about counseling. We believe our work will be most helpful to you when you have a clear idea of what we are trying to do. This document also contains important information about our professional services and business policies. Please read it carefully and jot down any questions you might have so we can discuss them at our next meeting. When you sign this document, it will represent an agreement between us.
ContractCounseling Services Agreement • March 31st, 2021 • California
Counseling Services Agreement and Informed ConsentCounseling Services Agreement • June 2nd, 2022
As a therapist I am specially trained to understand and treat mental, emotional, and relational problems. Your counseling may include various forms of psychotherapy depending on your needs and motivation. I may work with you individually or as a member of a couple, family or group. This is a voluntary agreement, and you may choose to terminate at any time. While I have a Master’s degree in Counseling, have passed the National Counselor Examination, and am a Licensed Professional Counselor with the state of South Carolina, no guarantees can be made regarding treatment outcomes.
Counseling Services AgreementCounseling Services Agreement • May 28th, 2021
Christine Rushford, LMHC, hereinafter referred to as Therapist, agrees to accept the undersigned person as a Client and provide Client with mental health counseling and or substance abuse treatment under the following terms and conditions:
Counseling Services Agreement Keirsten J. Roath, LCSWCounseling Services Agreement • August 1st, 2020
Counseling Services: Most people enter into counseling to heal suffering, to increase well-being and to explore and ultimately understand and move through emotional and psychological obstacles in their lives. It is my belief that effective counseling is guided by the expertise you have about yourself and your willingness to enter into a mutually respectful and professional relationship with a counselor. It is normal to experience uncomfortable feelings such as sadness, anger, frustration, guilt and helplessness during the therapeutic process as well as difficulties in relationships and/or life routines as you make positive changes. On the other hand, counseling has been shown to have benefits such as solutions to specific problems, better relationships and significant reductions in distressful feelings. There are, however, no guarantees in what each individual will experience through counseling.
COUNSELING SERVICES AGREEMENTCounseling Services Agreement • July 8th, 2020
OFFICE POLICIES & GENERAL INFORMATION AGREEMENT TO PROVIDE COUNSELING SERVICESCounseling Services Agreement • March 1st, 2019
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 (client’s) written permission, except where disclosure is required by law.
Counseling Services Agreement and Consent for TreatmentCounseling Services Agreement • January 30th, 2022
Goals and Expectations: To obtain maximum benefit from counseling services, I agree to be an active participant in treatment, which includes keeping all scheduled appointments, following through with referrals, and completing activities discussed in sessions. The ultimate goal of services is to eventually be discharged from treatment after accomplishing my treatment goals. As I voluntarily consent to treatment, I am also free to withdraw consent and discontinue treatment at any time. Similarly, this practice has the right to refer me to a more appropriate treatment setting. If I do not remain active in treatment or allow more than 60 days to pass without contact, Frederick Counseling reserves the right to close the treatment file.
Counseling Services AgreementCounseling Services Agreement • December 31st, 2019
Welcome! The following information is provided to clarify the nature and limitations of the counseling services that I offer.
Frederick Counseling LLCCounseling Services Agreement • May 24th, 2018
Goals and Expectations: To obtain maximum benefit from counseling services, I agree to be an active participant in treatment, which includes keeping all scheduled appointments, following through with referrals, and completing activities discussed in sessions. The ultimate goal of services is to eventually be discharged from treatment after accomplishing my treatment goals. As I voluntarily consent to treatment, I am also free to withdraw consent and discontinue treatment at any time. Similarly, this practice has the right to refer me to a more appropriate treatment setting. If I do not remain active in treatment or allow more than 60 days to pass without contact, Frederick Counseling reserves the right to close the treatment file.
FIRST AMENDMENT TO THE AGREEMENT BETWEEN REDWOOD CITY SCHOOL DISTRICT AND ONE LIFE COUNSELINGCounseling Services Agreement • September 19th, 2024
THIS AMENDMENT, entered into this 9 day of October, 2024, by and between the REDWOOD CITY SCHOOL DISTRICT (hereinafter called DISTRICT), a political subdivision of the State of California, and ONE LIFE COUNSELING
COUNSELING SERVICES AGREEMENTCounseling Services Agreement • August 30th, 2016
AGREEMENT FOR INDIVIDUAL COUNSELING SERVICESCounseling Services Agreement • March 19th, 2020
Counselors communicate with clients through the Secure Patient Portal, which is part of clients’ electronic medical record (see below); counselors also contact clients by phone. Except in certain circumstances, counselors do not communicate with clients by e-mail. To contact your counselor through the Secure Patient Portal, visit our website, and log-in with your Blazer ID and password.
ContractCounseling Services Agreement • August 12th, 2021
AGREEMENT FORM COUNSELING SERVICESCounseling Services Agreement • February 3rd, 2014
Welcome to counseling services. Please read the following information carefully and if you have any questions please discuss them with your counselor.
ContractCounseling Services Agreement • April 24th, 2018 • California
ANDCounseling Services Agreement • May 9th, 2023 • California
This Contract is by and between the COUNTY OF ORANGE, hereinafter referred to as “COUNTY,” and THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, a Corporation
ContractCounseling Services Agreement • September 21st, 2015
Welcome to Silver Linings Counseling (SLC). This document is important to you and/or your child as a consumer of services at SLC and is directly applicable to you as a client of SLC. This Agreement contains important information about our 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 client rights with regard to the use and disclosure of Protected Health Information (PHI) for the purpose of treatment, payment, and health care operations. HIPAA requires that we provide you with a Notice of Policies and Practices to Protect the Privacy of Your Health Information for use and disclosure of PHI for treatment, payment, and health care operations. This Notice, which is included with this Agreement, explains HIPAA and its application to your personal health information in greater detail. The law requires that we obtain your signature ack
Counseling Services AgreementCounseling Services Agreement • December 31st, 2019
Welcome! The following information is provided to clarify the nature and limitations of the counseling services that I offer.
Counseling Services Agreement and Consent for TreatmentCounseling Services Agreement • December 22nd, 2021
Goals and Expectations: To obtain maximum benefit from counseling services, I agree to be an active participant in treatment, which includes keeping all scheduled appointments, following through with referrals, and completing activities discussed in sessions. The ultimate goal of services is to eventually be discharged from treatment after accomplishing my treatment goals. As I voluntarily consent to treatment, I am also free to withdraw consent and discontinue treatment at any time. Similarly, this practice has the right to refer me to a more appropriate treatment setting. If I do not remain active in treatment or allow more than 60 days to pass without contact, Frederick Counseling reserves the right to close the treatment file.
Policies & General Information Agreement to Provide Counseling ServicesCounseling Services Agreement • February 21st, 2022
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 (client’s) written permission, except where required by law. For clients engaged in couple or conjoint therapy both participants (clients) must give written permission for release of information, except where required by law.
OpenDoorCounseling Services Agreement • August 23rd, 2021
Counseling is a very personal process and requires active effort on your part. Your therapist uses a cognitive behavioral (focus on your thinking and behavior) approach and other methods to help you deal with the problems that you hope to address. Please feel free to ask any questions you may have concerning the counseling process.
COUNSELING SERVICES AGREEMENTCounseling Services Agreement • August 7th, 2018
This Agreement contains information about my professional services and business poli- cies. It also contains summary information about the Health Insurance Portability and Accounta- bility Act (HIPAA), a federal law for privacy protections and patient rights. HIPAA requires that I provide you with a separate Notice of Privacy Practices and requires your signature acknowl- edging that I have provided you with this information. I’m happy to discuss any questions you have about my procedures or business practices.
SECOND AMENDMENT TO THE AGREEMENT BETWEENCounseling Services Agreement • November 18th, 2024
THIS AMENDMENT, entered into this 11 day of December, 2024, by and between the REDWOOD CITY SCHOOL DISTRICT (hereinafter called DISTRICT), a political subdivision of the State of California, and ONE LIFE COUNSELING,
COUNSELING SERVICES AGREEMENTCounseling Services Agreement • March 6th, 2013
The Church agrees to make payment up to the following limit unless further negotiated: NOT TO EXCEED LIMIT: $ or # of sessions Effective Date for Agreement (if different than signature date)
Agreement to Enter into Counseling ServicesCounseling Services Agreement • June 5th, 2016
About Back on Track LLC: Back on Track LLC is a limited liability company in the state of Georgia that provides psychotherapy and professional counseling services as well as educational and support services for children and their families. All therapists are either fully licensed or associate licensed professional counselors in the state of Georgia and participate in appropriate supervision and peer consultation as well as ongoing continuing education.
AGREEMENT FORM COUNSELING SERVICESCounseling Services Agreement • October 7th, 2020
Welcome to counseling services. Please read the following information carefully and if you have any questions please discuss them with your counselor.
Agreement for Counseling Services and Office PoliciesCounseling Services Agreement • July 4th, 2017
The fact that you are in my office is confidential, as is all information disclosed within sessions; nothing may be revealed without your permission. However, I have an ethical and legal obligation to break confidentiality if any of the following occur:
Counseling Services AgreementCounseling Services Agreement • December 18th, 2022
Welcome. This document contains important information about my professional services and business policies. Please read it carefully and be sure to let me know if you have any questions. If you decide to sign this document, it will constitute an agreement between us.
COUNSELING SERVICES AGREEMENT & INFORMED CONSENTCounseling Services Agreement • June 24th, 2015
NOTE: If you are seeing me for couple’s therapy, each person must fill out and bring a separate set of the following forms to your first session.
PARAKLEIN COUNSELING and CONSULTATION SERVICES CONTRACTUAL AGREEMENTCounseling Services Agreement • November 11th, 2004
In an effort to enhance communication and to clarify the relationship between the counselor and the client, the following guidelines are set forth:
OFFICE POLICIES AND COUNSELING SERVICES AGREEMENTCounseling Services Agreement • February 8th, 2018
The following are policies and procedures of Untethered Therapy Group. This information is provided to assist you in making the most informed decision about your treatment. In addition, this document (“Agreement”) constitutes an agreement between MentWell Inc., a Pennsylvania Nonprofit Corporation doing business as Untethered Therapy Group (“us,” “we,” or “Untethered Therapy Group”) and you
Constance Cromartie, NCC, LPCCounseling Services Agreement • September 27th, 2016
This is an agreement between Constance Cromartie, LPC, known from here forth as ‘the counselor’ and , known from here forth as ‘the client’ for professional mental health counseling services to be provided by the counselor to the client.
