Office Policies and General Information Agreement for Psychotherapy Services Sample Contracts

OFFICE POLICIES AND GENERAL INFORMATION AGREEMENT FOR PSYCHOTHERAPY SERVICES
Office Policies and General Information Agreement for Psychotherapy Services • October 19th, 2023

This form provides you (patient) with information that is additional to that detailed in the notice of privacy practices and it is subject to HIPAA preemptive analysis.

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Dr. Sara Denman, PsyD
Office Policies and General Information Agreement for Psychotherapy Services • January 24th, 2023

CONFIDNTIALITY: All information disclosed within sessions and the written records pertaining to those sessions are confidential and may not be revealed to anyone without your (patient’s) written permission, except where disclosure is required by law.

OFFICE POLICIES AND GENERAL INFORMATION AGREEMENT FOR PSYCHOTHERAPY SERVICES
Office Policies and General Information Agreement for Psychotherapy Services • February 1st, 2011

Participation in therapy can result in a number of benefits to you, including improving interpersonal relationships and resolution of the specific concerns that led you to seek therapy. Working toward these benefits, however, requires effort on your part.

Joe Stapp, MA, LPC, NCC
Office Policies and General Information Agreement for Psychotherapy Services • December 18th, 2017
OFFICE POLICIES AND GENERAL INFORMATION AGREEMENT FOR PSYCHOTHERAPY SERVICES
Office Policies and General Information Agreement for Psychotherapy Services • February 18th, 2021

A typical therapy session lasts 55-60 minutes, unless planned otherwise. If a client is a minor, the parents/guardians are expected to be onsite while children are within the counseling session and to appropriately supervise any children within the waiting area, so as to not disturb others. Please be considerate that other therapists will be in counseling sessions while you are in the waiting room. I will always be available to discuss with you, your thoughts or feelings regarding therapy and its progress. Therapeutic approaches that may be used are trauma informed modalities, EMDR therapy (Eye Movement Desensitization Reprocessing), play therapy, sandplay therapy, internal family systems, developmental assessments, psychoeducational assessments, and SMART (sensory, motor, arousal, regulation treatment). If Ms. Wilcox is unable to provide an appropriate treatment that you would benefit from, she has an ethical obligation to assist you in obtaining those treatments from an appropriate p

Jill A. Selbach, Ph.D., P.A. Venetian Isle Office Building drselbach@aol.com 2211 East Sample Road
Office Policies and General Information Agreement for Psychotherapy Services • September 26th, 2022
OFFICE POLICIES AND GENERAL INFORMATION AGREEMENT FOR PSYCHOTHERAPY SERVICES
Office Policies and General Information Agreement for Psychotherapy Services • March 21st, 2008

This form provides you (patient) with information that is additional to that detailed in the Notice of Privacy Practices.

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