Therapy_Agreement

Therapy Agreement

_____________________________ (hereafter "Therapist") and _______________________ (hereafter "Client"), hereby agree to the following:

The Client will meet with the Therapist every {frequency} at the Therapist's office at {address} from {start time} to {end time} at a rate of {monetary amount} per session.

The Client is primarily attending therapy sessions to address {subject} but understands that other issues may arise over the course of the sessions, making predicting or controlling the projected necessary number of sessions impossible. The Client may continue therapy as long as {he/she} wishes, and {he/she} may discontinue therapy at any time.

Any cancelled or deferred sessions require {amount of time} advance notice or the Client will be charged {fee}.

With advanced notice of at least {amount of time} and in cases of an emergency, the Therapist may be able to accommodate a Skype session in lieu of an in-person meeting.

Communication through the Therapist's phone line {line} is confidential and secure. The Therapist's email, {address}, is available but not verified as a secure option.

During individual sessions, sensitive and personal information may come up. The Therapist grants full confidentiality to the Client, except in the following limited conditions:

• If the Client is a minor, {his/her} parents may have access by law to treatment records. The Parents may sign a waiver [attached] to waive this right.
• The Therapist is bound by law to notify the appropriate parties and/or authorities if the Client threatens to harm another person.
• The Therapist may reach out to necessary parties if {he/she} believes that the Client is a danger to {himself/herself}.
• The Therapist must report any suspicion that a dependent (child or elderly or incompetent person) is being abused.
• If a court of law legally requires it, the Therapist must provide treatment records or testimony to that court.

The Client swears and attests that {he/she} will not subpoena testimony from or require the court presence of the Therapist for any reason, including divorce proceedings or child custody hearings.

The Therapist will not make any acknowledgement of the Client in public spaces unless the Client acknowledges the Therapist first. This is to ensure the Client's privacy.

In witness to their agreement to the terms of this contract, the parties affix their signatures below:

_____________________________________
(Client signature and date)

_____________________________________
(Therapy signature and date)

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