Informed Consent For Psychotherapy (Adult/ Couple): Office Policies & General Information AgreementInformed Consent for Psychotherapy • October 4th, 2021
This Agreement has been created for the purpose of outlining the terms and conditions of services to be provided by Sonoma Family Therapy Inc. for you herein “Client” and is intended to provide you with important information regarding the practices, polices and
Jennifer Furey, LPC, LLC ♦ Counseling and PsychotherapyInformed Consent for Psychotherapy • March 11th, 2021
Welcome to my practice! I know the decision to chose a therapist is a difficult one, and I see it as a privilege to work with you. Outlined below are my office policies and procedures, as well as important information about your rights and risks of therapy. Please read them carefully before signing. I am happy to discuss any questions or concerns you may have at any time.
Informed Consent For PsychotherapyInformed Consent for Psychotherapy • October 1st, 2020
This document is intended to provide important information to you regarding your treatment. Please read the entire document carefully and be sure to ask your therapist any questions that you may have.
Restoring Family HarmonyInformed Consent for Psychotherapy • January 5th, 2021
This form provides you, the client, with information that is additional to that detailed in the Notice of Privacy Practices and it is subject to HIPAA preemptive analysis.
Office Policies, General Information Agreement for Psychotherapy Services & Informed Consent for PsychotherapyInformed Consent for Psychotherapy • May 25th, 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.
Dr. Matthys Moreno-Derks, PSY 32259 Email: mamoreno24@gmail.com Phone: 760-554-3507Informed Consent for Psychotherapy • March 6th, 2022
This form provides you, the client, with information that is additional to that detailed in the Notice of Privacy Practices and it is subject to HIPAA preemptive analysis.
ContractInformed Consent for Psychotherapy • September 21st, 2024
Informed Consent for PsychotherapyInformed Consent for Psychotherapy • May 10th, 2023
The therapeutic relationship is a unique and highly personal contractual agreement. This consent provides a framework for our work together by managing expectations and understanding how our relationship will work. Feel free to ask questions and discuss any or all contents of this Informed Consent with me and any point during our therapeutic relationship.
ContractInformed Consent for Psychotherapy • March 21st, 2024
This form provides additional information to that detailed in the Notice of Privacy Practices and it is subject to HIPAA preemptive analysis.
Practice Policies & General Information Agreement for Psychotherapy Services or Informed Consent for PsychotherapyInformed Consent for Psychotherapy • May 10th, 2019
Office Policies & General Information Agreement for Psychotherapy Services or Informed Consent for PsychotherapyInformed Consent for Psychotherapy • July 28th, 2018
This form provides you, the client, with information that is additional to that detailed in the Notice of Privacy Practices and it is subject to HIPAA preemptive analysis.
Restoring Family HarmonyInformed Consent for Psychotherapy • October 1st, 2011
This form provides you, the client, with information that is additional to that detailed in the Notice of Privacy Practices and it is subject to HIPAA preemptive analysis.
Office Policies & General Information Agreement for Psychotherapy Services or Informed Consent for PsychotherapyInformed Consent for Psychotherapy • May 23rd, 2015
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.
Dr. Jane Bolton, PsyD, LMFT (34888)Informed Consent for Psychotherapy • July 20th, 2017
