Service Agreement & Informed Consent for
Therapy
General Information
The therapeutic relationship is unique in that it is a highly personal and, at the same time, a contractual agreement. Given this, it is important for us to reach a clear understanding about how our relationship will work, and what each of us can expect. This agreement will provide a clear framework for our work together. Feel free to discuss any of this with me. Please read and indicate that you have reviewed this information and agree to it by filling in the checkbox at the end of this document.
The Therapeutic Process
You have taken a very positive step by deciding to seek therapy. The outcome of your treatment depends largely on your willingness to engage in this process, which may, at times, result in considerable discomfort. Remembering unpleasant events and becoming aware of feelings attached to those events can bring on strong feelings of anger, depression, anxiety, etc. There are no miracle cures. I cannot promise that your behavior or circumstance will change. I can promise to support you and do my very best to understand you and repeating patterns, as well as to help you clarify what it is that you want for yourself.
Scheduling and Cancellation Policy
I strive to make scheduling and attending appointments as convenient and seamless as possible. You can easily schedule appointments via my website or by emailing me directly. Please be aware that due to high demand, appointment availability may be limited and subject to change. To ensure you secure your preferred time, I recommend booking your appointment 2-3 weeks in advance.
I understand that life happens, and I allow appointment cancellations without charge up to 24 hours prior to the scheduled appointment time. If you need to cancel within 24 hours of your appointment time, I will charge the full fee for the scheduled service. This includes no-shows. Late arrivals will still be charged the full fee.
For my ACC and EAP clients, there is a specific protocol to adhere to. ACC covers 5 missed sessions per annum, and after this, you will be liable to pay the $190 cancellation fee. EAP clients will have one of their sessions deducted from their total number of available sessions if cancellations occur later than 24 hours before the appointment.
I highly value my clients and their time, and I work hard to accommodate everyone in a timely manner. Therefore, late cancellations or no-shows can greatly impact my scheduling and the ability to accommodate other clients. I hope you understand and appreciate your cooperation with my scheduling and cancellation policies.
Cost of Services
I am excited to work with you and provide the best service possible. My payment process is clear and straightforward. Upon attending an appointment, you will receive an invoice within 24 hours. I request that payment is made within 7 days of receiving the invoice. Payment options available are bank transfer or credit card. If you are covered by ACC's Sensitive Claims Service (SCS) or an Employee Assistance Program (EAP), I am happy to bill the respective organisation directly. However, if you have private insurance, please note that you will be required to pay upfront and request a refund from your insurance. I greatly appreciate your understanding and cooperation in this regard.
Confidentiality
The session's content and all relevant materials to your treatment will be held confidential unless you request in writing to have all or portions of such content released to a specifically named
person/persons. Limitations of such client held privilege of confidentiality exist and are itemized below:
1.If a client threatens or attempts to commit suicide or otherwise conducts him/her self in a manner in which there is a substantial risk of incurring serious bodily harm.
2.If a client threatens grave bodily harm or death to another person.
3.If the therapist has a reasonable suspicion that a client or other named victim is the perpetrator, observer of, or actual victim of physical, emotional or sexual abuse of children under the age of 18 years.
4.Suspicions as stated above in the case of an elderly person who may be subjected to these abuses.
5.Suspected neglect of the parties named in items #3 and # 4.
6.If a court of law issues a legitimate subpoena for information stated on the subpoena.
7.If a client is in therapy or being treated by order of a court of law, or if information is obtained for the purpose of rendering an expert's report to an attorney.
Occasionally I may need to consult with other professionals in their areas of expertise in order to provide the best treatment for you. Information about you may be shared in this context without using your name or other identifying information.
If we see each other accidentally outside of the therapy office, I will not acknowledge you first. Your right to privacy and confidentiality is of the utmost importance to me, and I do not wish to jeopardize your privacy. However, if you acknowledge me first, I will be more than happy to speak briefly with you in a manner that appears appropriate while being out in public or outside of the therapy office.
Termination of Services
I understand that circumstances can change and that sometimes the best course of action is to terminate therapy services. With this in mind, I want to inform you that both you and I reserve the right to terminate therapy services at any time, with or without cause, verbally or in writing. I will consider services terminated if I am unable to reach you or if you haven't engaged with me for an extended period of time. For ACC clients, I will close the claim within two months of the last attended appointment while EAP claims will be closed within four weeks. Any remaining fees will be due and payable within 7 days of the last appointment.
Please note that I still maintain the right to terminate the agreement immediately in certain situations. If I feel that you pose a danger to yourself or others, engage in illegal or unethical behaviour, or if continued therapy services would be inappropriate or unproductive, I reserve the right to terminate the agreement on the spot.
However, if you decide to terminate the agreement, please do not hesitate to discuss your reasons with me. I encourage open conversation, and I will work with you to explore alternative therapy options if necessary. I may even be able to recommend you to other mental health professionals who can provide the care and support you need.
If you have any questions about the termination process or any other part of this service agreement, please know that I am here to help. Do not hesitate to reach out to us, and we will respond as soon as possible.
Contact Us
+64 28 438 0451
contact@feelseitig.com
Wanaka & Queenstown, NZ.