AGREEMENT TO ACCEPT SERVICES AND FINANCIAL RESPONSIBILITY STATEMENTPsychotherapeutic Services Agreement • September 17th, 2014
Agreement for Psychotherapeutic ServicesPsychotherapeutic Services Agreement • April 10th, 2023
Confidentiality: All information disclosed within sessions and the written records pertaining to those sessions are confidential and may not be revealed to anyone without the patient’s written permission, except where disclosure is required by law or professional ethics. In couple and family therapy, confidentiality and privilege do not apply between the couple or among family member patients. In this case I will use my clinical judgment when sharing information to the couple or family member patients. Unless otherwise required by law (see below) I will not release records to any outside party without written authorization to do so by all adults who are part of the treatment. When consulting with other psychotherapist, regarding ways to best serve my patients, my patient’s identities remain completely anonymous, and confidentiality is fully maintained.
