Please read the following
information carefully. It is your responsibility to understand the
conditions of establishing a counseling agreement prior to entering into the
counseling relationship. Continuing into the counseling relationship, is
considered your acceptance and understanding of these terms. Should you
have any questions concerning this agreement, please call 1-415-692-4032.
All clients engaging in Phone counseling, must be 18
years of age or older.
Privacy & Confidentiality:
All communications are conducted in a private setting and held in strict
confidence. Information shared can not be released by the counselor to
anyone except for the follow exceptions: (1) A client reveals the thoughts
or plans to harm themselves or others. (2) Reveals any situation that may be
considered abuse or danger to a child or elderly individual. (3) With clients written consent. If you have any concenrs regarding the first two points than it would be advised that on intake you request Anonymity: so when you enter into a counseling session, only your
user name will be provided to the Counselor – no other information will be
provided to the Counselor .
Security of Telephone Counseling:
The telephone will be used to collect personal information.Telephone counseling
services are provide utilizing standard telephone equipment and services.
Client agrees to provide counselor with the telephone number they wish to
utilize for this service. The call will be made at the scheduled session
time. Client holds responsibility for establishing a comfortable
environment for themselves, without risk of interruptions or distractions.
Client is also asked to disengage telephone features such as call waiting
and call block for the session time.
Limitations Of Services:
 | Online and Telephone Counseling may not be the most appropriate modes of counseling services for certain situations or individual issues. |
| Clients in an emergency situation or crisis, and/or experiencing thoughts of suicide, self harm or harming others, must call 911 immediately. |
| Before entering into a counseling relationship, client agrees to a
brief evaluation of needs, and will enter into the agreed mode of
counseling services at their own risk. |
Evaluation for Services:
Prior to setting an appointment, each client must provide as much
information as possible, so counselor may briefly evaluate clients needs.
This will be done by telephone on intake. The purpose is to establish the
client's needs and appropriate mode of services.
Fee Agreement:
Fees are to be paid prior to services provided. Only Credit cards will be accepted.
Missed or Canceled Appointments:
Client agrees to cancel appointments at least 24 hours in advance.
Clients not giving proper cancellation notice, will be charged a $50.00
fee for each missed appointment.
Fee Refunds:
Refunds will be given for the following reasons:
| Client gives at least 24 hours notice to cancel prepaid appointment. |
| Counselor fails to keep the appointment. |
Equipment Failure:
One of the disadvantages of utilizing telephone and computer/Internet
technology is the unforeseen equipment failure. Should client or
counselor lose connection during an online session, both will attempt to
reconnect immediately. No charges are accrued during this reconnect
time. Should reconnection not be immediately possible, the time remaining
for your session will be credited to another session time. Counselor does
not accept responsibility for any technical difficulties that could
occur. Should technical failure prohibit an online session, alternative
arrangements or another scheduled session will be made.
Referrals for Additional Services:
Occasionally the client may need additional services not offered by
counselor. Counselor will provide client with referrals if possible.
However, client holds the responsibility and risk for contacting and
accepting these services and their outcomes.
Termination of Services:
Client or counselor may choose to terminate the counseling relationship at
any time. The party choosing to terminate the relationship, agrees to
contact the other party through e-mail or written letter, with reasons
for termination. Client may choose to terminate the counseling
relationship at anytime. Counselor may terminate relationship if they
feel the client has reached their goals, the client is not progressing
under the counselors care, or the counselor is not qualified to provide
the services needed at this time. Counselor agrees to provide client with
referrals for more appropriate services should this be needed.
On Intake you will be agreeing
to all conditions stated in this policy and will sign an intake form to that affect.
