New Path Addictions & General Counseling

New Path Addictions & General Counseling

Example Service Agreement - What to Expect:

 

Welcome to “New Path Addictions & General Counseling.” 

 

This document contains important information about my professional services and business policies. Please read it carefully and jot down any questions you might have so that we can discuss them during our next meeting or by phone/email if you wish. When you sign this document, it will represent an agreement between us. 

 

COUNSELING SERVICES

 

Counseling, Addictive Behaviour Counseling, General Counseling, Addictions Counseling, Online Counseling, are not easily described in general statements. It varies depending on the personalities of the counselor and client, and the particular problems you bring forward. There are different methods I may use to deal with the problems that you hope to address. Counseling is not like a medical doctor visit. Instead, it calls for a very active effort on your part. In order for the sessions to be most successful, you will have to work on things we talk about both during our sessions and at home.

 

Counseling can have benefits and risks. Since counseling often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. On the other hand, counseling has also been shown to

have benefits for people who go through it. Counseling often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress. But there are no guarantees of what you will experience.

 

Our first few sessions will involve an evaluation of your problem situations, your needs, your goals, and what you wish to get out of counseling. By the end of the evaluation, I will be able to offer you some first impressions of what our work will include and we can begin to put together a treatment plan based on your goals, if you decide to continue with counseling. You should evaluate this information along with your own opinions of whether you feel comfortable working with me. Counseling may involve a large commitment of time, money, and energy, so you should be very careful about the counselor you select. If you have questions about “New Path Addictions & General Counseling” or my counseling procedures and services, we should discuss them whenever they arise. If your doubts persist, I will be happy to assist you set up a meeting with another Counselor as near as possible to your area of residence for a second opinion.

 

SESSIONS

 

I normally conduct an evaluation that will last anywhere from 1 to 3 sessions. During this time, we can both decide if I am the best person to provide the services you need in order to meet your goals. If counseling is begun, on average I will schedule one 60 minute session per week at a time we agree upon, although some sessions may be longer or more or less frequent. Once an appointment hour is scheduled, you will be expected to pay for it unless you provide 24 hours advance notice of cancellation unless we both agree that you were unable to attend due to

circumstances beyond your control. If it is possible, I will try to find another time to reschedule the appointment.

 

PROFESSIONAL FEES

 

My hourly fee is $90.00, however, I also have a sliding scale rate which can be agreed upon prior to the first session if you are experiencing financial hardship and have proof thereof. In addition to weekly appointments, I charge $65.00 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 may include report writing, telephone conversations lasting longer than 15 minutes, attendance at meetings with other professionals you have authorized and have consented to, preparation of records or counseling 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 $140 per hour for preparation and attendance at any legal proceeding.

 

BILLING AND PAYMENTS

 

You will be expected to pay for each session at the time it is held. Payment schedules for other professional services will be agreed to when they are requested. In circumstances of unusual financial hardship, I may be willing to negotiate a fee adjustment or payment installment plan. If your account has not been paid for more than 90 days and arrangements for payment have not been agreed upon, I have the option of using legal means to secure the payment. This may involve hiring a collection agency or going through small claims court. If such legal action is

necessary, its costs will be included in the claim. In most collection situations, the only information I release regarding a patient’s treatment is his/her name, the nature of services provided, and the amount due. 

 

CONTACTING ME

 

I may not be immediately available by telephone. While I am usually working between 9 AM and 5 PM, I may not be able to answer the phone for reasons such as if I am with a client. You can always leave a voice message on my phone (or contact me by email) and I will get back to you as quickly as possible. As in any case, if it is an emergency call 911 immediately or go to your local emergency department. When I am unavailable, my telephone is answered by voice mail that I monitor frequently. I will make every effort to return your call on the same day you make it, with the exception of weekends and holidays. If you are difficult to reach, please inform me of some times when you will be available. If you are unable to reach me and feel that you can’t wait for me to return your call, contact your family physician or go to the nearest hospital. If I will be unavailable for an extended time, I will provide you with the name of a colleague or agency to contact, if necessary. 

 

PROFESSIONAL RECORDS

 

The laws and standards of my profession require that I keep counseling records. You are entitled to receive a copy of your records, or I can prepare a summary for you instead. Because these are professional records, they can be misinterpreted and/or upsetting to untrained readers. If you wish to see your records, I recommend that you review them in my presence so that we can discuss the contents. Clients will be charged an appropriate fee for any professional time spent in responding to information requests.

 

MINORS

 

If you are under eighteen years of age, please be aware that the law may provide your parents the right to examine your treatment records. It is my policy to request an agreement from parents that they agree to give up access to your records. If they agree, I will provide them only with general information about our work together, unless I feel there is a high risk that you will seriously harm yourself or someone else. In this case, I will notify them of my concern. I will also provide them with a summary of your treatment when it is complete. Before giving them any information, I will discuss the matter with you, if possible, and do my best to handle any objections you may have with what I am prepared to discuss. At the end of your treatment, I will prepare a summary of our work together for your parents, and we will discuss it before I send it to them. If you are under 16 years of age it is our policy to refer you to an appropriate agency that specializes in working with youth under 16 years of age. 

 

CONFIDENTIALITY

 

In general, the privacy of all communications between a client and a counselor is protected by law, and I can only release information about our work to others with your written permission. But there are a few exceptions. In most legal proceedings, you have the right to prevent me from providing any information about your treatment. In some proceedings involving child custody and those in which your emotional condition is an important issue, a judge may order my testimony if he/she determines that the issues demand it. There are some situations in which I am legally obligated to take action to protect others from harm, even if I have to reveal some information about a patient’s treatment. For example, if I believe that a child, elderly person, or disabled person is being abused, or going to be abused/harmed, I may be required to inform the appropriate authorities or file a report with the appropriate agency.

 

If I believe that a patient is threatening serious bodily harm to another, I am required to take protective actions. These actions may include notifying the potential victim, contacting the police, or seeking hospitalization for the client. If the patient threatens to harm himself/herself, I may be obligated to seek hospitalization for him/her or to contact family members or others who can help provide protection.

 

I may occasionally find it helpful to consult other professionals about a case. During a consultation, I make every effort to avoid revealing the identity of my patient. The consultant is also legally bound to keep the information confidential. If you don’t object, and there is no need to identify you, I will not tell you about these consultations unless I feel that it is important to our work together. If it is required that I need to identify you during the consultation, I will request you sign a consent form. While this written summary of exceptions to confidentiality should prove helpful in informing you about potential problems, it is important that we discuss any questions or concerns that you may have at our next meeting/session or any time. I will be happy to discuss these issues with you if you need specific advice, but formal legal advice may be needed because the laws

governing confidentiality are quite complex, and I am not an attorney. If you request, I will provide you with relevant portions or summaries of the Provincial laws regarding these issues. If you are in the United States, I will forward the local state laws that may apply to you if requested once I have obtained them.

 

Your signature below indicates that you have read the information in this document and agree

to abide by its terms during our professional relationship.

 

Name (Printed): _________________________________________________________

Name (Signature): _______________________________________________________

Date: __________________________________________________________________

 

Rev. August 26, 2010

New Path Addictions Counseling

Counseling Services Contract