TERMINATION OF TREATMENT. If I determine that I cannot provide appropriate services to you for any reason, I will terminate our treatment and refer you to other professionals. If you request and authorize it in writing, I will talk to the new therapist in order to help with the transition. If at any time you want another professional’s opinion or wish to consult with another therapist, I will assist you with referrals. Upon termination of therapy for any reason, the termination will be confirmed in writing. Professional Fees: My fee for individual therapy is set at $140 per 50 minute session. Other services or no-show/late cancellation fees may have varying charges. You are expected to pay for each session at the time it is held. In addition to psychotherapy sessions, I charge this amount for other professional services you may need or request, such as report writing, telephone conversations of ten minutes or more, consultation with other professionals with your written permission, and preparation of records or treatment summaries. The time spent performing any other service you may request of me will incur additional charges. I will pro-rate the cost if I work for periods of less than 45 minutes. Please note that the “therapy hour” is actually 45- to 50 minutes in length, and is the usual session duration. Litigation Policy: Due to the nature of the therapeutic process and the fact that it often involves making a full disclosure with regard to many matters which may be of a confidential nature, it is agreed that should there be legal proceedings (including but not limited to divorce and custody disputes, injuries, lawsuits, etc..), neither you, your attorneys or anyone acting on your behalf will subpoena records from my office, or subpoena me to testify in court or in any legal proceeding. By your signature below, you agree to abide by this agreement. If I am subpoenaed to provide records or testimony in violation of this agreement, you acknowledge and agree you will pay for all of my professional time, including preparation and transportation costs, even if I am called to testify by another party. If you become involved in any legal matter that requires my services, there is a fee of $250 per hour and this includes preparation time, travel time, attendance at any legal proceeding or any other time spent in this endeavor. I also reserve the right to terminate our professional, therapeutic relationship immediately and refer you to other mental health providers. I will NOT provide c...
TERMINATION OF TREATMENT. The length of time required for therapy will be determined by your personal situation. Your clinician will do their best to fulfill your therapeutic needs and provide you with the best therapeutic care. For your part, you agree to participate in the process to the best of your ability. It is intended that when your needs are met, to the extent they can be, the therapeutic relationship will terminate. Although many people report benefits from therapy, there is no guarantee of a cure. • For your part, you may terminate services at any time. This may be done in several ways. These include, but are not limited to, putting it in writing or informing your therapist verbally. If you choose to terminate therapy, it will be your clinician’s decision as to whether we can re-establish our therapeutic relationship if you request to do so in the future. • A pattern of frequently canceled or missed appointments will result in termination. In such circumstances, referrals to other therapists or agencies will be provided if requested. • Non-payment for services may result in termination. • If your therapist feels that the services they can offer are not or will not be appropriate for you, they may, after discussing reasons with you, refer you to another provider or agency. Furthermore, we reserve the right to terminate service if dangerous/risky behaviors are continued or if sessions are attended after consuming drugs or alcohol.
TERMINATION OF TREATMENT. Initial/ Physical Assault, verbally threatening behavior towards staff, other patients, or physical property, and/or significant disruption of the office environment will be cause for immediate termination of treatment and you will be held responsible for damages. Firearms and other weapons are prohibited, with exception for an officer of the law. Non-compliance with treatment (missed appointments, failure to follow treatment plans, misuse of medications, and violation of any office policies) is grounds for termination of treatment.
TERMINATION OF TREATMENT. If I feel that the services I can offer are not, or will not be appropriate for you, I may, after discussing reasons with you, refer you to another provider or agency. Furthermore, I reserve the right to terminate service if treatment recommendations are not followed. Such situations include: if payment is not timely, if recommended consultations are not sought, if medication is not taken as prescribed mental health continuity, if dangerous practices are continued, or if sessions are attended after consuming drugs or alcohol.
TERMINATION OF TREATMENT. You are under no obligation to continue services and may opt to terminate treatment. Should you decide to discontinue treatment, we strongly urge you to notify the doctor of your decision so that it may be discussed openly.
TERMINATION OF TREATMENT. You have the right to decide to end treatment at any time and for any reasons. If you are thinking about ending therapy, we encourage you to discuss this with your therapist so that they may minimize terminating treatment against medical advice. If termination of treatment is indicated, we can provide you with names of other mental health providers. Your therapist has the right to terminate therapy due to, but not limited to, the following reasons: untimely payment of fees, failure to comply with treatment recommendations, conflict of interest, failure to participate in therapy, a client’s needs are outside the therapist’s scope of competence or practice, or a client is not making adequate progress in therapy. If you cancel and/or miss six (6) consecutive scheduled appointments in a row, this is considered as inactive and you will be discharged and terminated from treatment.
TERMINATION OF TREATMENT. You have the right to terminate therapy/psychiatric service at any time and for any reason. It is our hope that termination of therapy will naturally come after you feel that you have made progress on all of your therapy goals and are feeling a general sense of well-being. You are encouraged to make an appointment in the future if you ever need a “check-up” or would like to restart therapy for different issues. For psychiatric treatment, it is important that you follow the advice of your prescriber and if you terminate services with him or her, do not stop your medication without their consent. CONSENT TO THERAPY: Your signature below indicates that you have read this Agreement and agree with its terms. Patient, Parent or Guardian Signature Date
TERMINATION OF TREATMENT. You have the right to terminate therapy at any time and for any reason. It is my hope that termination of therapy will naturally come after you feel that you have made progress on all of your therapy goals and are feeling a general sense of well-being. You are encouraged to make an appointment in the future if you ever need a “check-up” or would like to restart therapy for different issues. CONSENT TO THERAPY: Your signature below indicates that you have read this Agreement and agree with its terms. Printed Name: Date:
TERMINATION OF TREATMENT. If at any point during psychotherapy I assess that I am not effective in helping you reach the therapeutic goals, I am obliged to discuss it with you and, if appropriate, to terminate treatment. In such a case, I will give a number of referrals that may be of help to you. If you request it and authorize it in writing, I will talk to the psychotherapist of your choice in order to help with the transition. If at any time you want another professional’s opinion or wish to consult with another therapist, I will assist you in finding someone qualified, and, if you provide a written consent, I will provide the essential information needed. You have the right to terminate therapy at any time. If you choose to do so, I will offer to provide you with the names of other qualified professionals whose services you might prefer. PROFESSIONAL FEES My hourly fee is $140.00. In addition to weekly appointments, I charge this amount for other professional services you may need, though I will break down the hourly cost if I work for periods of less than one hour. Other services include report writing, telephone conversations lasting longer than 5 minutes, attendance at meetings with other professionals you have authorized, preparation of records or treatment summaries, and the time spent performing any other service you may request of me. If you become involved in legal proceedings that require my participation, you will be expected to pay for my professional time even if I am called to testify by another party. Because of the difficulty of legal involvement, I charge $300 per hour for preparation and attendance at any legal proceeding door to door.
TERMINATION OF TREATMENT. Your participation in therapy is voluntary and you have the right to end therapy whenever you want. However, if you do decide to exercise this option, we encourage you to talk with your doctor about the reason for your decision in a counseling session together. We ask that you allow for two final ses- sions with your doctor in order to have an ending together, to review what we’ve done and to offer feedback to each other. Likewise, your doctor reserves the right to end the therapy work together and provide you with some appropriate referrals. This may be for reasons including, but not limited to: failure to participate in therapy, conflicts of interest, untimely payment of fees, or your doctor’s belief that they may not be the best person for your needs (due to expertise). Any reason will be discussed prior to termination. Your signature below indicates that you have read the Informed Consent & Therapy Agreement, have received a copy, and agree to abide by its terms during our professional relationship. Printed Name of Client Client Signature (or guardian if a minor) Date
