Common use of Termination of Therapy Clause in Contracts

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. During the first one to four sessions of therapy, I understand that will assess your status, diagnosis, needs and goals and define L Q L W L D O W U H D W P H Q W U H F R P P H Q G D W the client to other qualified clinicians. I have reserve the right to terminate therapy at any timemy discretion. In such a case, I also understand that my therapist reserves the right to will give you a number of referrals you can contact. Some reasons where I might terminate therapy at his/her discretion. Reasons for termination may could include, but are not limited to, your failure to provide paperwork Xxxx Xxxx Counseling Center deems as absolutely necessary by the second session of therapy, your failure to comply with treatment recommendations, conflicts of interest, failure to participate in therapy, my your needs are outside the therapist’s of my scope of competence or practice, I am practice or you are not making adequate progress in therapy. Should any of the above occur, or untimely payment I will give you a number of feesreferrals that will be appropriate for you. I understand that should either my therapist or I decide You have the right to terminate therapytherapy at any time. However, I may be asked to will recommend that you participate in at least one, or possibly more, one termination sessions session in order to facilitate a positive termination experience review progress and give us both an opportunity to reflect on the work that has been donecover recommendations for other therapists who might assist you. I also understand that my therapist will attempt to ensure a smooth transition to another therapist by offering referrals to me. Acknowledgment: CLIENT AND COUNSELOR SIGNATURES P–LEASE SIGN BELOW By my signature signing this below, I certify client(s) acknowledge that I you have reviewed the information and have been given the opportunity to ask questions and have them answered. I fully understand the information contained in terms and conditions of this documentAgreement. I Client(s) has discussed terms and conditions with Intern therapist, and has had any questions with regards to its terms and conditions answered to client(s) satisfaction. Client(s) agree to abide by the terms and conditions of this Agreement and consent to participate in psychotherapy with my therapistAgreement. Moreover, I Client(s) also agree to hold my Intern 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. Client Signature Dated Client Signature Dated Client Signature Dated MFT Intern Dated For the adult(s) who have the legal authority under the law to consent for the minor -aged person to receive counseling services from Anthropos: As the parent(s) or guardian(s) of , I have been given the undersigned give my consent to , to provide counseling treatment to . By signing below, I acknowledge the necessity of confidentiality between my minor and his/her therapist which best supports the creation of an effective counseling relationship. I, therefore, wa L Y H P \ U L J K W W R N Q R Z W confidential records of the minor with the possible exception of a copy of summary as noted in this document for my own recordsAgreement. Dated: , 20 Client Name (please print) Parent/Guardian Signature of Client (if Client is 12 or older) Signature of Representative (and relationship to minor)Date

Termination of Therapy. In our initial sessions, you and I understand that 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 the right 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 also understand that my therapist reserves reserve the right to terminate therapy at his/her my discretion. Reasons for termination may include, but are not limited to, untimely payment of fees, failure to comply with treatment recommendations, conflicts of interest, failure to participate in therapy, my a client’s needs are outside the therapist’s of my scope of competence or practice, I am or a client is not making adequate progress in therapy, or untimely payment . If either of fees. I understand that should either my therapist or I decide us decides to terminate therapy, I may be asked to will generally recommend that you participate in at least one, or possibly more, termination sessions. These sessions in order are intended to facilitate a positive termination experience and give both of us both an opportunity to reflect on the work that has been done. I will also understand that my therapist will attempt to ensure a smooth transition to another therapist by offering referrals to mereferrals. Acknowledgment: Acknowledgment By my signature signing below, I certify you acknowledge that I you have reviewed the information and have been given the opportunity to ask questions and have them answered. I fully understand the information contained in terms and conditions of this documentagreement. I You have discussed such terms and conditions with Xxxxxxxx Xxxxxxxx and have had any questions with regard to its terms and conditions answered to your satisfaction. You agree to abide by the terms and conditions of this Agreement agreement and consent to participate in psychotherapy with my therapistthe therapeutic process. Moreover, I you agree to hold my therapist Xxxxxxxx Xxxxxxxx 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) Client Signature of / Date Client Name (if Client is 12 or older) Signature of Representative (and relationship to minorplease print)

Termination of Therapy. I The following reasons may be cause to terminate our client contract:  Behavior of a client (e.g., repeated tantrums, refusing to engage in therapy, refusing to follow directions or recommendations, verbal abuse, etc.). We anticipate and understand that I all clients have “bad days,” however if the right behavior is ongoing we may recommend a change in clinician. If the behaviors continue to persist after that point despite a variety of strategies implemented by the clinician(s), you will be referred to another facility.  Behavior of a parent/guardian.  Non-compliance with our attendance policy.  Repeatedly not paying an account. You will receive a warning when there is an outstanding account balance with multiple payments due. If we do not receive your payment within 2-weeks upon receipt of that warning, therapy will be placed on hold until payments are rendered in full. Your child may lose his/her appointment slot and be placed on a waiting list at that time. Continued non-payments will result in termination of services.  Engaging in behavior that breaches trust such as withholding pertinent information about the case history or asking us to alter our data or diagnosis. If you need to terminate therapy at for any timereason, we ask that you give us written notice a minimum of two (2) sessions in advance. I also understand that my therapist This will allow us adequate time to wrap-up therapy and complete consultation with you. A therapy termination form will be provided for you to complete. Let’s Talk Speech & Language Therapy Services, LLC, 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 cancel or practice, I am not making adequate progress in therapyamend this contract, or untimely payment any part therein without negating the remainder of feesthe contract. I understand that should either my therapist Clients will be notified, in writing, of any changes 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 cancellation 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 treatmentcontract. I have been given a copy read and accept the terms of this document for my own recordscontract. Dated: Signed this _ day of . Xxx Xxxxxxx, 20 Client Name (please print) Signature of Client (if Client is 12 or older) Signature of Representative (and relationship to minor)MS, CCC-SLP Client/Parent/Guardian Co-owner Let’s Talk Speech & Language Therapy Center, LLC Xxxxxxx Xxxxx, MA, CCC-SLP Co-owner

Termination of Therapy. In our initial sessions, you and I understand that 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 the right 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 also understand that my therapist reserves reserve the right to terminate therapy at his/her my discretion. Reasons for termination may include, but are not limited to, untimely payment of fees, failure to comply with treatment recommendations, conflicts of interest, failure to participate in therapy, my a client’s needs are outside the therapist’s of my scope of competence or practice, I am or a client is not making adequate progress in therapy, or untimely payment . If either of fees. I understand that should either my therapist or I decide us decides to terminate therapy, I may be asked to will generally recommend that you participate in at least one, or possibly more, termination sessions. These sessions in order are intended to facilitate a positive termination experience and give both of us both an opportunity to reflect on the work that has been done. I will also understand that my therapist will attempt to ensure a smooth transition to another therapist by offering referrals to mereferrals. Acknowledgment: Acknowledgment By my signature signing below, I certify you acknowledge that I you have reviewed the information and have been given the opportunity to ask questions and have them answered. I fully understand the information contained in terms and conditions of this documentagreement. I You have discussed such terms and conditions with Xxxxxxxx Xxxxxxxx and have had any questions with regard to its terms and conditions answered to your satisfaction. You agree to abide by the terms and conditions of this Agreement agreement and consent to participate in psychotherapy with my therapistthe therapeutic process. Moreover, I you agree to hold my therapist Xxxxxxxx Xxxxxxxx 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) Client Signature of / Date Client Name (if please print) Client is 12 or older) Signature of Representative (and relationship to minor)/ Date

Termination of Therapy. In our initial sessions, you and I understand that 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 the right 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 also understand that my therapist reserves reserve the right to terminate therapy at his/her my discretion. Reasons for termination may include, but are not limited to, untimely payment of fees, failure to comply with treatment recommendations, conflicts of interest, failure to participate in therapy, my a client’s needs are outside the therapist’s of my scope of competence or practice, I am or a client is not making adequate progress in therapy, or untimely payment . If either of fees. I understand that should either my therapist or I decide us decides to terminate therapy, I may be asked to will generally recommend that you participate in at least one, or possibly more, termination sessions. These sessions in order are intended to facilitate a positive termination experience and give both of us both an opportunity to reflect on the work that has been done. I will also understand that my therapist will attempt to ensure a smooth transition to another therapist by offering referrals to mereferrals. Acknowledgment: Acknowledgment By my signature signing below, I certify that I I/we are entering into this counseling services contract with full understanding, participation, and consent. By signing below, the client and parents/guardians (if client is under 18 years old) consent for the client to receive counseling services and state they have reviewed the information read 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 above policies and conditions of this Agreement and consent to participate in psychotherapy with my therapistprocedures. 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 printGuardian(s) Signature of Signature/Date Client (if Client is 12 or olderGuardian(s) Signature of Representative (and relationship to minor)Signature/Date

Termination of Therapy. It is impossible to guarantee any specific results regarding your counseling goals, but we will work together to achieve the best results possible. At the end of this session we will decide if we want to enter a counseling relationship. If we both agree to begin a counseling relationship, you will sign, date, and keep a copy of this informed consent, and I understand that will be considered your therapist until termination occurs or until I have not seen you in session for more than 4 weeks from the date of our last session. Your decision to choose to enter counseling is a voluntary one and you may terminate it at any time. If at some point ethical standards dictate it is in your best interest to refer you to another therapist, I will do so, i.e. a specialist in another field. If I believe your issues are above my level of competence, or outside of my scope of practice, I am legally required to refer, terminate, or consult. If this happens I would provide you with names of professionals to contact. It is always your right to terminate therapy at any time. However, I also understand that strongly encourage you to discuss this decision with me. I will always give you my therapist reserves professional opinion as far as the timing of termination and will be open to discussing this with you. If for whatever reason you decide to terminate therapy without notification, you will be officially released as a client after 30 days unless otherwise notified. Any client is free to re-establish the therapist-client relationship after termination at any time which he or she sees fit. I reserve the right to terminate therapy at his/her my discretion. Reasons for termination may include, but are not limited to, untimely payment of fees, failure to comply with treatment recommendations, conflicts of interest, failure to participate in therapy, my if your needs are outside the therapist’s of my scope of competence or practice, I am or you are not making adequate progress in therapy, or untimely payment of fees. I understand that should You have the right to terminate therapy at your discretion. Upon either my therapist or I decide party’s decision to terminate therapy, I may be asked to will generally recommend that you participate in at least one, or possibly more, termination sessions. These sessions in order are intended to facilitate a positive termination experience and give us both an opportunity to reflect on the work that has been doneexperience. I will also understand that my therapist will attempt to ensure a smooth transition to another therapist by offering referrals to meyou. AcknowledgmentContacting Me My phone number: By my signature below000-000-0000 My email address: xxxxx@xxxxxxx-xxxxxxxxxx.xxx (for scheduling appointments and non-clinical matters only) I ask that clients limit text messages and email for administrative purposes only such as scheduling appointments. Do not send confidential information by email or text as there is never a 100% guarantee information sent electronically will remain confidential. Do not text or email emergencies but call me at the number I provided you. Please see the Social Media Policy for more information. My office hours are Monday, Tuesday, and Wednesday, 9:00 a.m. to 5:00 p.m. I certify that I have reviewed return routine calls during those hours by the information and have been given close of the opportunity to ask questions and have them answerednext business day. 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 treatmentreturn crisis calls as soon as possible seven days a week. I have been given a copy confidential voice mail that allows you to leave a message at any time. I will make every effort to return calls within 24 hours (or by the next business day), but cannot guarantee the calls will be returned immediately. If you are experiencing a life-threatening crisis and cannot reach me, you may call the Colorado Crisis Hotline 000- 000-0000; 911, or check yourself into the nearest hospital. I will also provide the number of this document a colleague when I am unavailable due to illness, training, or travel. From time-to-time, I may engage in telephone contact with you for purposes other than scheduling sessions. You are responsible for payment of the agreed upon fee (on a pro rata basis) for any telephone calls longer than ten minutes (see Fees Section above). In addition, from time-to-time, I may engage in telephone contact with third parties at your request and with your advance written authorization. You are responsible for payment of the agreed upon fee (on a pro rata basis) for any telephone calls longer than ten minutes (see Fees section above). I travel approximately 2-3 times a year for periods of 1-2 weeks. Whenever possible, I will let you know at least a month in advance of my own recordsdeparture. Dated: , 20 Client Name (please print) Signature I will also leave you the name of Client (if Client is 12 or older) Signature a respected mental health counselor you can contact in case of Representative (and relationship to minor)emergency while I am away.