Termination of Therapy. Therapist reserves the right to terminate therapy at his/her discretion. Reasons for termination include, but are not limited to, untimely payment of fees, failure to comply with treatment recommendations, conflicts of interest, failure to participate in therapy, Patient needs are outside of Therapist’s scope of competence or practice, or Patient is not making adequate progress in therapy. Patient has the right to terminate therapy at his/her discretion. Upon either party’s decision to terminate therapy, Therapist will generally recommend that Patient participate in at least one, or possibly more, termination sessions. These sessions are intended to facilitate a positive termination experience and give both parties an opportunity to reflect on the work that has been done. Therapist will also attempt to ensure a smooth transition to another therapist by offering referrals to Patient.
Termination of Therapy. The length of your treatment and the timing of the eventual termination of your treatment depend on the specifics of your treatment plan and the progress you achieve. It is a good idea to plan for your termination, in collaboration with your ther- apist. Your therapist will discuss a plan for termination with you as you approach the completion of your treatment goals. You may discontinue therapy at any time. If you or your therapist determines that you are not benefiting from treatment, either of you may elect to initiate a discussion of your treatment alternatives. Treatment alternatives may include, among other possibilities, referral, changing your treatment plan, or terminating your therapy.
Termination of Therapy. Therapist reserves the right to terminate therapy at her discretion, for reasons including but not limited to untimely fee payment, noncom- pliance with treatment recommendations, conflict of interest, failure to participate in therapy, or Patient needs being outside Therapist’s scope of practice or compe- tence. Patient also has the right to terminate therapy at his/her discretion. Upon either party’s decision to terminate, Therapist will usually recommend Patient par- ticipate in at least one termination session to facilitate a positive termination experi- ence and allow both parties to reflect on the work that has been done. Therapist will also attempt to ensure a smooth transition to another therapist by offering referrals to Patient. Acknowledgment: By signing below, Patient acknowledges that he/she has re- viewed and fully understands the terms and conditions of this Agreement. Patient has discussed the terms and conditions with Therapist, and any questions have been answered to Patient’s satisfaction. Patient agrees to abide by the terms and conditions of this Agreement and consents to participate in psychotherapy with Therapist. Patient Name (please print): Patient Signature: Date: Therapist Signature: Date: Xxxxxxx X. Xxxxxxx, XX, MA, LMFT xxxxxxxxxxxxxx.xxx CREDIT CARD AGREEMENT: Please Note: New clients are requested to keep a valid credit card number on file. Please complete the following information and provide your credit card to your clinician at your initial session. This is set up for your convenience. Credit Card Type: MasterCard Visa American Express Discover Name as shown on card: Credit Card Number: Expiration date: 3-digit security code on back of the card: If American Express, 4-digit code on front of the card: Billing Address associated with this credit/debit card: Email Address: This card may be charged for (Please initial all that apply): • Regular session fees (at your request, as a convenience to you): • Fees for same-day cancellation: • Fees for cancellation without 24-hour notice: • Delinquent session fees (fees more than 30 days overdue): • Document review (including emails, Court records, and correspondence) (charged in 10-minute increments): • Phone calls over ten minutes (with clients and collateral contacts) (charged in 10-minute increments): • I understand there are no refunds given: “I have read and understand the terms of provid- ing my credit card to Xxxxxxx X. Xxxxxxx, XX, MA, LMFT. I understand that my credit card m...
Termination of Therapy. The Therapist reserves the right to terminate therapy at his/her discretion. Reasons for termination include, but are not limited to, untimely payment of fees, failure to comply with treatment recommendations, conflicts of interest, failure to participate in therapy, the Client’s needs are outside of the Therapist’s scope of competence or practice, or the Client is not making adequate progress in therapy. The Client has the right to terminate therapy at his/her discretion. Upon either party’s decision to terminate therapy, the Therapist will generally recommend that the Client participate in at least one, or possibly more, termination sessions. These sessions are intended to facilitate a positive termination experience and give both parties an opportunity to reflect on the work that has been conducted. The Therapist will also attempt to ensure a smooth transition to another Therapist by offering referrals to the Client. Acknowledgement: By signing below, the Representative acknowledges that he/she has reviewed and fully understands the terms and conditions of this agreement. The Representative has discussed such terms and conditions with the Therapist, and has had any questions with regard to its terms and conditions answered to the Representative’s satisfaction. The Representative agrees to abide by the terms and conditions of this Agreement and consents to the Client’s participation in psychotherapy with the Therapist. Moreover, the Representative agrees to hold the Therapist free and harmless from any claims, demands, or suits for damages from any injury or complications whatsoever, save negligence, that may result from such treatment. I understand that I am financially responsible to the Therapist for all charges, including unpaid charges by my insurance company or any other third-party payor. AGREEMENT FOR SERVICE/INFORMED CONSENT SIGNATURE PAGE: Client Name (Please Print) Signature of Client (or authorized Representative) Date Name of Responsible Party (if other than client) please print.
Termination of Therapy. The length of your treatment and the timing of the eventual termination of your treatment depend on the specifics of your treatment plan and the progress you achieve. It is a good idea to plan for your termination, in collaboration with me. I will discuss a plan for termination with you as you approach the completion of your treatment goals.
Termination of Therapy. I understand that the number of sessions and timing of the eventual termination of therapy will depend on my particular goals and the progress I achieve. I understand that I may discontinue therapy at any time. If Xx. Xxxxxx Xxxxxxxxx Colmer, LMFT or I determine that I am not benefiting from treatment, I agree that either of us may elect to initiate a discussion of treatment alternatives, which may include adjusting or changing my goals, being referred to another provider, or terminating therapy. I have carefully read the information in this agreement and fully understand all the areas covered. Name (Print)
Termination of Therapy. The length of your treatment and the timing of the eventual termination of your treatment depend on the specifics of your treatment plan and the progress you achieve. It is a good idea to plan for your termination, in collaboration with me. I will discuss a plan for termination with you as you approach the completion of your treatment goals. You may discontinue therapy at any time. If I determine that you are not benefiting from treatment, I may elect to initiate a discussion of your treatment alternatives. Treatment alternatives may include, among other possibilities, referral, changing your treatment plan, or terminating your therapy. Your signature indicates that you have read this agreement for services carefully and understand its contents. Please ask me to address any questions or concerns that you have about this information before you sign! Name of Patient
Termination of Therapy. I understand that I have the right to terminate therapy at any time. I also understand that my therapist reserves the right to terminate therapy at his/her discretion. Reasons for termination may include, but are not limited to, failure to comply with treatment recommendations, conflicts of interest, failure to participate in therapy, my needs are outside the therapist’s scope of competence or practice, I am not making adequate progress in therapy, or untimely payment of fees. I understand that should either my therapist or I decide to terminate therapy, I may be asked to participate in at least one, or possibly more, termination sessions in order to facilitate a positive termination experience and give us both an opportunity to reflect on the work that has been done. I also understand that my therapist will attempt to ensure a smooth transition to another therapist by offering referrals to me. Acknowledgment: By my signature below, I certify that I have reviewed the information and have been given the opportunity to ask questions and have them answered. I fully understand the information contained in this document. I agree to abide by the terms and conditions of this Agreement and consent to participate in psychotherapy with my therapist. Moreover, I agree to hold my therapist free and harmless from any claims, demands, or suits for damages from any injury or complications whatsoever, save negligence, that may result from such treatment. I have been given a copy of this document for my own records. Dated: , 20 Client Name (please print) Signature of Client (if Client is 12 or older) Signature of Representative (and relationship to minor)
Termination of Therapy. The length of patient’s treatment and the timing of the eventual termination of their treatment depend on the specifics of their treatment plan and the progress they achieve. It is a good idea to plan for patient’s termination, in collaboration with their therapist. Patient’s therapist will discuss a plan for termination with Representative and patient as you approach the completion of patient’s treatment goals. Patient may discontinue therapy at any time. If patient or their therapist determines that they are not benefitting from the treatment, either of you may elect to initiate a discussion of your treatment alternatives. Treatment alternatives may include, among other possibilities, referral, changing your treatment plan, or terminating your therapy. Therapist reserves the right to terminate therapy at his/her discretion. Reasons for termination include, but are not limited to, untimely payment of fees, failure to comply with treatment recommendations, conflicts of interest, failure to participate in therapy, Patient needs are outside of Therapist’s scope of competence or practice, or Patient is not making adequate progress in therapy. Patient or Representative has the right to terminate therapy at his/her discretion. Upon either party’s decision to terminate therapy, Therapist will generally recommend that Patient participate in at least one, or possibly more, termination sessions. These sessions are intended to facilitate a positive termination experience and give both parties an opportunity to reflect on the work that has been done. Therapist will also attempt to ensure a smooth transition to another therapist by offering referrals to Patient or Representative.
Termination of Therapy. In our initial sessions, you and I should pay careful attention to whether or not we feel comfortable working together. In addition, part of my responsibility includes assessing if the services I am offering can be helpful to you. If you have any questions about my work or procedures, please discuss them with me whenever they arise. If your doubts persist, you are free to seek an opinion from another mental health professional or to terminate therapy at any time. I reserve the right to terminate therapy at my discretion. Reasons for termination include, but are not limited to, untimely payment of fees, failure to comply with treatment recommendations, conflicts of interest, failure to participate in therapy, a client’s needs are outside of my scope of competence or practice, or a client is not making adequate progress in therapy. If either of us decides to terminate therapy, I will generally recommend that you participate in at least one, or possibly more, termination sessions. These sessions are intended to facilitate a positive termination experience and give both of us an opportunity to reflect on the work that has been done. I will also attempt to ensure a smooth transition to another therapist by offering referrals.
