Disclosure, Treatment and Fee Agreement Sample Contracts

Kate Daigle, M.A., NCC Kate Daigle Counseling, LLC 709 Clarkson St.
Disclosure, Treatment and Fee Agreement • April 11th, 2023

My therapeutic approach stems from a strengths-­‐based perspective and advocates for recognizing the impact of cultural values and backgrounds when designing the course of therapy. I utilize several different therapeutic modalities that are sensitive to and tailored for aiding my clients’ direct needs, and the foundation for my theory is grounded in person-­‐ centered therapy and the postmodern approach of Narrative therapy. I use traditional as well as alternative approaches, such as body-­‐centered psychotherapy, dialectical behavioral therapy (DBT), cognitive behavioral therapy (CBT), motivational interviewing, solution-­‐focused therapy, and meditative practice.

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DISCLOSURE, TREATMENT, AND FEE AGREEMENT
Disclosure, Treatment, and Fee Agreement • December 18th, 2016

Degrees and Credentials: LPC, CACII, EMDR trained, Masters of Arts Student in Counseling, Bachelors of Arts in Biblical Studies Associates of Applied Science in Early Childhood Education

DISCLOSURE, TREATMENT, AND FEE AGREEMENT
Disclosure, Treatment, and Fee Agreement • April 1st, 2020

The Colorado State Department of Regulatory Agencies regulates the practice of psychotherapy for licensed and registered psychotherapists. Concerns regarding the practice of psychotherapy may be directed to the Department of Regulatory Agencies, Mental Health Section, 1560 Broadway, Suite #1340, Denver, Colorado 80202; Ph: (303) 894-7800.

Contract
Disclosure, Treatment, and Fee Agreement • June 12th, 2018

SAMANTHA SMITH, LMHC INTUITIVE COUNSELING LLC 3318 BRIDGEPORT WAY W D5 UNIVERITY PLACE WA 98466 DISCLOSURE, TREATMENT, AND FEE AGREEMENTLicensed Mental Health Counselor (2017) #LH60782603MA in Professional Counseling (2015) Liberty University Washington State Law requires that counselors practicing counseling for a fee must be registered or licensed with Washington State Department of Health for the protection of the public health and safety. Registration of an individual with the department does not include recognition of any practice standards, nor necessarily implies the effectiveness of any treatment. Client Rights As a consumer of psychotherapy, it is important to understand your rights as a consumer under the state of Washington and know the background of your counselor. All certified therapists are regulated by state laws and under code of ethics. Samantha follows the code of ethics provided by AMHCA and ACA. Licensure requires 2 years of experience after obtaining a master

DISCLOSURE, TREATMENT, AND FEE AGREEMENT—“VALUED RELATIONSHIPS”
Disclosure, Treatment, and Fee Agreement • October 17th, 2018
Disclosure, Treatment and Fee Agreement
Disclosure, Treatment and Fee Agreement • February 23rd, 2020

Method of Treatment: You may receive information about the methods of treatment, techniques used, duration of therapy if known, and the fee structure. You have the right to terminate treatment at any time. Please be advised that in a professional relationship, sexual intimacy is never appropriate and should be reported to the board that licenses, registers, or certifies the licensee, registrant or certificateholder.

Disclosure, Treatment and Fee Agreement Form
Disclosure, Treatment and Fee Agreement • June 24th, 2022

My therapeutic approach stems from a strengths-­‐based perspective. I see each of my clients as a person who is inherently whole and who possesses the tools for their own healing. To support my clients in embracing these tools, I utilize several different therapeutic modalities that are tailored to my clients’ direct needs. I have been trained in Acceptance and Commitment Therapy (ACT) and also utilize concepts from Narrative Therapy, person-­‐centered therapy, mindfulness meditation, body-­‐centered psychotherapy, dialectical behavioral therapy (DBT), cognitive behavioral therapy (CBT), motivational interviewing, and solution-­‐focused therapy. If you have questions about my training, please ask.

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