CLIENT AGREEMENT & INFORMED CONSENT

Welcome to my practice. This document contains important information about my professional services and business policies. Please read it carefully and let me know if you have any questions. When you sign this document, it will represent an agreement between us. If you decide that you do not wish to consent to these services and policies and, therefore, would not like to proceed with services here, there will be no charge for our meeting today.

I ask that you review, and sign this document where shown. Successful therapy requires a commitment by both the therapist and the client.


The following policies have been established for my private practice.

Please sign at the bottom showing that you agree, acknowledge, and/or understand:

This will be used to send appt reminders, some homework, etc..
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Select all that you are comfortable with

As a mental health therapist, I need to have legal documentation of child custody before I can provide services to a potential client who is a minor. This is to ensure that I have the proper consent from the parent or guardian who has the legal authority to make decisions about the child's health care. Legal documentation of child custody can include a court order, a divorce decree, or a written agreement between the parents. 

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