COUNSELING SERVICES AGREEMENTCounseling Services Agreement • July 8th, 2020
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.
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
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.
COUNSELING SERVICES AGREEMENTCounseling Services Agreement • August 30th, 2016
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.
CHILD COUNSELING SERVICES AGREEMENTCounseling Services Agreement • March 4th, 2014
This is to certify that I consent on behalf of my child to counseling: Initial The hourly fee for all appointments not cancelled 24 hours in advance will be charged.
CHILD COUNSELING SERVICES AGREEMENTCounseling Services Agreement • October 21st, 2020
This is to certify that I consent on behalf of my child to counseling: Initial The hourly fee for all appointments not cancelled 24 hours in advance will be charged.
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.
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.
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)
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.
Counseling Services Agreement Jordan Psychological Assessment Center Brieanna Claassen, MA, LPC, NCCCounseling Services Agreement • January 6th, 2021
Welcome! The following information is provided to clarify the nature and limitations of the counseling services offered by Brieanna Claassen, MA, LPC, NCC. Ms. Claassen is a Licensed Professional Counselor in the state of Kansas as well as a National Certified Counselor. She has a Master of Arts in Marriage, Couple, and Family Counseling from MidAmerica Nazarene University. She is a member of the American Counseling Association and the Association for Play Therapy and abides by the ethical codes delineated by these professional associations. Ms. Claassen is currently working toward her post-graduate certification in play therapy at MidAmerica Nazarene University (expected July, 2016). Ms. Claassen conducts individual and family counseling utilizing an attachment theory and family systems-based approach, and her preferred modality of treatment is Emotion-Focused Therapy for adult individuals and couples and Child-Centered Play Therapy for children; however, techniques from other theoret
CHILD COUNSELING SERVICES AGREEMENTCounseling Services Agreement • December 25th, 2020
This is to certify that I consent on behalf of my child to counseling: Initial The hourly fee for all appointments not cancelled 24 hours in advance will be charged.
