THE CHRYSALIS GROUP INC.Psychotherapy Agreement • May 7th, 2024
PSYCHOTHERAPY AGREEMENT and INFORMED CONSENTPsychotherapy Agreement • January 3rd, 2024
Psychotherapy is a process designed to help you address your concerns, come to a greater understanding of yourself, and learn effective personal and interpersonal coping strategies. It involves a relationship between you and the therapist; a relationship within which therapy can take place and the individual’s goals can be achieved. The duration of therapy is dependent on a number of factors including your goals, time-frame, rate of progress, etc. It should be noted that psychotherapy resulting in lasting change is often a long-term process, lasting several months or longer. Please discuss any issues/concerns you have with your therapist so that an appropriate treatment plan can be formulated which will best suit your needs/desires. The relationship between therapist and client is the container through which client change can take place. As such, it is often one in which close emotional bonds develop. It is also a professional relationship, in which appropriate boundaries must be maint
Psychotherapy Agreement (Spring Creek Home, Inavale, NE)Psychotherapy Agreement • July 28th, 2015
Psychotherapy AgreementPsychotherapy Agreement • April 14th, 2023
It is my aim to provide you with a meaningful opportunity to explore your personal and relational issues in a safe environment. I aim to facilitate, support and guide you without judgement or prejudice. If at any time I feel I can no longer help you, I will offer to refer you to someone else. I will support any desire on your part to seek an alternative therapist and will assist you through this process.
Psychotherapy AgreementPsychotherapy Agreement • May 23rd, 2009
Welcome to my practice and thank you for your business. This document contains important information about my professional services and business policies. Please read it carefully and jot down any questions that you have so that we may discuss them at our next session.
Phone: 949 494 5432Psychotherapy Agreement • May 29th, 2019
PSYCHOTHERAPY AGREEMENTPsychotherapy Agreement • June 17th, 2019
Welcome to NYC Therapy Group. These guidelines have been written to inform you, the client, about the basic terms, conditions and professional practices that promote a successful therapy experience.
PSYCHOTHERAPY AGREEMENTPsychotherapy Agreement • October 2nd, 2012
Please read it carefully. If this Psychotherapy Agreement is acceptable to both of you, please sign the last page. If you have any questions, let’s discuss them at our next meeting.
Psychotherapy AgreementPsychotherapy Agreement • November 9th, 2020
At Arkansas Families First, we strive to provide high-quality mental health services to help improve the life of every patient we encounter. The following will explain our policies and procedures and will serve as a contract between the clinician and the patient.
Psychotherapy Agreement (Boone County Health Center, Albion, NE)Psychotherapy Agreement • July 28th, 2015
AGREEMENT FOR PSYCHOTHERAPY AND CLIENT CONSENT FORMPsychotherapy Agreement • January 8th, 2018
Welcome to the private psychotherapy and consultation practice of Dr .Beth Firestein and Inner Source Psychotherapy. The following paragraphs provide information that is important to you as a client or consultee. Please read the following information carefully and feel free to ask questions if you need further clarification.
PSYCHOTHERAPY AGREEMENT and INFORMED CONSENTPsychotherapy Agreement • April 9th, 2023
Psychotherapy is a process designed to help you address your concerns, come to a greater understanding of yourself, and learn effective personal and interpersonal coping strategies. It involves a relationship between you and the therapist; a relationship within which therapy can take place and the individual’s goals can be achieved. The duration of therapy is dependent on a number of factors including your goals, time-frame, rate of progress, etc. It should be noted that psychotherapy resulting in lasting change is often a long-term process, lasting several months or longer. Please discuss any issues/concerns you have with your therapist so that an appropriate treatment plan can be formulated which will best suit your needs/desires. The relationship between therapist and client is the container through which client change can take place. As such, it is often one in which close emotional bonds develop. It is also a professional relationship, in which appropriate boundaries must be maint
Psychotherapy Agreement (Brodstone Memorial Hospital, Superior, NE)Psychotherapy Agreement • March 4th, 2015
Psychotherapy AgreementPsychotherapy Agreement • October 14th, 2020
At Arkansas Families First, we strive to provide high-quality mental health services to help improve the life of every patient we encounter. The following will explain our policies and procedures and will serve as a contract between the clinician and the patient.
Phone: 425-209-8216Psychotherapy Agreement • January 21st, 2020
When people enter into any kind of relationship in which services are exchanged, it is a good idea to be clear about each person’s rights and responsibilities. My hope is to use this document as a way to introduce myself and explain about psychotherapy. This is an agreement of sorts. This agreement tells you what you can expect of me and what I can expect of you. Please read it carefully and be sure to ask me to explain anything you do not understand or that you have concerns about.
Psychotherapy agreementPsychotherapy Agreement • July 23rd, 2022
Please use the contact details below to arrange or change appointments. Messages can be left on my voice mail. Please visit the website for more information on psychosynthesis and services offered, www.psychosynthesisscotland.com
Psychotherapy agreement (контракт на психотерапию)Psychotherapy Agreement • April 9th, 2021
This contract is an agreement that regulates work relationships between a therapist and a client. The aim of the contract is to establish boundaries in professional relationships for the safety of the client, the clinical work and the psychotherapist. The signing of this contract supersedes all previous therapeutic contract between the client and therapist.
AGREEMENT TO ENTER PSYCHOTHERAPYPsychotherapy Agreement • March 23rd, 2020
Information and Agreement for PsychotherapyPsychotherapy Agreement • December 20th, 2019
Welcome to the private practice Tasha Felton, LCPC. I want this to be a positive and helpful experience for you and would like to begin by giving you important information that may affect your therapy experience. If you have any questions or special concerns, please feel free to discuss them with me during your first session, or any time thereafter.
Balanced Awakening, P.C.Psychotherapy Agreement • October 28th, 2020
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.
Amy Schiller, PhD, LCSW LLCPsychotherapy Agreement • December 27th, 2021
CONFIDENTIALITY: Your verbal communication and clinical records are strictly confidential, except where: 1) the client authorizes a release of information with his/her signature; 2) the client presents a physical danger to self or others; 3) child/elder abuse/neglect is suspected. In the latter two cases, we are required by law to report this information to the proper legal authorities so that protective measures can be taken.
PSYCHOTHERAPY AGREEMENT and INFORMED CONSENTPsychotherapy Agreement • September 28th, 2021
Psychotherapy is a process designed to help you address your concerns, come to a greater understanding of yourself, and learn effective personal and interpersonal coping strategies. It involves a relationship between you and the therapist; a relationship within which therapy can take place and the individual’s goals can be achieved. The duration of therapy is dependent on a number of factors including your goals, time-frame, rate of progress, etc. It should be noted that psychotherapy resulting in lasting change is often a long-term process, lasting several months or longer. Please discuss any issues/concerns you have with your therapist so that an appropriate treatment plan can be formulated which will best suit your needs/desires. The relationship between therapist and client is the container through which client change can take place. As such, it is often one in which close emotional bonds develop. It is also a professional relationship, in which appropriate boundaries must be maint
PSYCHOTHERAPY AGREEMENTPsychotherapy Agreement • September 14th, 2017
EXPECTATIONS: Psychotherapy can be helpful in a variety of ways, including to assist you with the psychological adjustments that can be associated with childhood traumas, the transition to adulthood (including in the areas of education, employment and relationships with others), intimate relationships, child- rearing, parenting, divorce, co-parenting, aging, care-giving, illness, disability, addiction and loss. It can be helpful in alleviating the symptoms of depression and anxiety, and help you develop additional coping and problem-solving skills or strategies. It can be used on a short-term basis to address specific needs and concerns, or on an on-going basis, to pursue more comprehensive self-awareness, personal development, change and well-being. Typically, psychotherapy occurs weekly, at the same time each week.
Julie Gerut, LCSWPsychotherapy Agreement • January 2nd, 2023
Welcome. This agreement contains information about my professional services and policies. It summarizes the most frequently discussed administrative issues.
Psychotherapy AgreementPsychotherapy Agreement • November 9th, 2020
Welcome! I invite you to thoughtfully read through this information as it is written for our mutual benefit. This document culminates with your signature indicating that you have read and agree to the terms of this Agreement. Everyone--regardless of race, cultural, spiritual, and sexual orientation--will be treated with respect. I reserve the right to decline treatment to any individual. Occasionally, this occurs when I believe that a Client’s specific needs would be better served by another therapist. This Agreement addresses:
into treatmentPsychotherapy Agreement • July 26th, 2022
provider of services. I acknowledge that this will be only for psychotherapy and the therapist will not conduct custody, visitation or parenting assessments. Discovery Psychotherapy Center will not write advocacy letters on behalf of parents or children as well as not testify in court. I/We should seek the services of a licensed forensic psychologist in such matters.
ContractPsychotherapy Agreement • June 19th, 2017
Welcome to my practice. This document (the Agreement) contains important information about my professional services and business policies. It also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a new federal law that provides new privacy protections and new patient rights with regard to the use and disclosure of your Protected Health Information (PHI) used for the purpose of treatment, payment, and health care operations. HIPAA requires that I provide you with a Georgia Notice of Privacy Practices (the Notice) for use and disclosure of PHI for treatment, payment and health care operations. The Notice, which is attached to this Agreement, explains HIPAA and its application to your personal health information in greater detail. The law requires that I obtain your signature acknowledging that I have provided you with this information at the end of this session. Although these documents are long and sometimes complex, it is very importan
MINORSPsychotherapy Agreement • May 28th, 2021
If you are under eighteen years of age, please be aware that the law may provide your parent(s)/guardian the right to examine your treatment records. It is the policy of TRUTH, HEALING & EVOLUTION LLC (T.H.E.), to request an agreement from parent(s)/guardian that they give up access to your records. If they agree, the T.H.E. counselor will provide them only with general information about the work the two of you perform together in the counseling process, unless he/she feels there is a high risk that you will seriously harm yourself or someone else. In this case, the T.H.E. counselor will notify your parents of this concern. The T.H.E. counselor will also provide your parents or guardian with a summary of your treatment when your treatment is completed. Before giving them any information, the counselor will discuss the matter with you, if possible, and do their best to handle any objections you may have with what is being prepared to discuss with them.
Psychotherapy AgreementPsychotherapy Agreement • January 16th, 2016
I, , consent to psychotherapeutic treatment with the therapist Tyler Ong, PsyD, MS. I have been provided the necessary information to voluntarily decide consent. I have been duly informed of the therapist’s qualifications, as well as the terms of the therapeutic relationship as follows:
Psychotherapy AgreementPsychotherapy Agreement • February 20th, 2022
Welcome! I invite you to thoughtfully read through this information as it is written for our mutual benefit. This document culminates with your signature indicating that you have read and agree to the terms of this Agreement. Everyone--regardless of race, cultural, spiritual, and sexual orientation--will be treated with respect. I reserve the right to decline treatment to any individual. Occasionally, this occurs when I believe that a Client’s specific needs would be better served by another therapist. This Agreement addresses:
Agreement to Receive Psychotherapy at Deeper Clarity Counseling Via Telehealth (online video)Psychotherapy Agreement • May 28th, 2021
Due to concerns regarding the Covid-19 (Coronavirus) pandemic, I, the undersigned, agree on this date to receive psychotherapy treatment with Lynn Flewelling, Deeper Clarity Counseling, via the Theranest Telehealth platform in my Client Portal account. I understand that I will receive the same level of care, and that this is for both my and Lynn’s safety. The video service is available on computer, phone, and tablet. It is your right to refuse, and to receive your usual face to face therapy instead. The Theranest portal is HIPPA compliant, meaning that your personal information, including credit card info, is secure.
Psychotherapy AgreementPsychotherapy Agreement • May 6th, 2013
At Arkansas Families First, we strive to provide high-quality mental health services to help improve the life of every patient we encounter. The following will explain our policies and procedures and will serve as a contract between the clinician and the patient.
AGREEMENT FOR PARENTSPsychotherapy Agreement • November 28th, 2021
We wish to enlist Heather Williams, LMFT, to provide psychotherapy treatment to our child / children. We recognize that such treatment will be compromised if information revealed therein may subsequently be brought to the attention of the court in the course of litigation.
AGREEMENT FOR MEETINGS WITH MY THERAPIST: PSYCHOTHERAPY AGREEMENT WITH A MINORPsychotherapy Agreement • July 23rd, 2020
Note to therapist: This form is intended to be used with older children or teens as a means to introduce the concept of confidentiality in therapy.
Information and Agreement for PsychotherapyPsychotherapy Agreement • September 8th, 2021
Welcome to the private practice of Joni Evans, M.S., LMFT, and LCPC. I want this to be a positive and helpful experience for you and would like to begin by giving you important information that may affect your therapy experience. If you have any questions or special concerns, please feel free to discuss them with me during your first session, or any time thereafter.
