The Therapist is engaged in the business of providing Counseling Services.

The Client wish to avail such services from the Therapist in accordance with the terms and conditions of this contract.

NOW, THEREFORE, FOR ALL GOOD AND VALUABLE CONSIDERATION, the Therapist and the Client hereby agree as follows:

Therapist and Client Goals. The Client desires to achieve the below goals to boost and reach their full potential in the following area(s) of his or her life as follows:

(a) The Therapist will seek to meet goals established by all persons involved, usually revolving around a specific presenting problem. A major benefit that may be gained from participating in the Counseling Services includes a reduction in distress and a better ability to handle or cope with personal, couple/marital/relational, family, work, and other problems as well as stress.

(b) Another possible benefit may be a greater understanding of personal and relational goals and values; this may lead to greater maturity and happiness as an individual and increased relational harmony.

(c) Other benefits relate to the probable outcomes resulting from resolving specific concerns brought to the Counseling sessions. Therapist will do their best to assess progress on a regular basis and solicit Client feedback regarding the process to help provide with the most effective services.

Scope of Services. The Client retains the above-referenced Therapist, and the Therapist agrees to perform for the Client, certain Services set forth to this Agreement. Any Service outside of the scope to this Agreement may require a new Agreement for other services agreed to by the Parties.

Consideration and Compensation. In exchange for the Services rendered by the Counselor/Coach, the Client agrees to compensate the Counselor/Coach as follows:

(a) Counseling service fee for individuals is $105.00 for each 50-minute session and $125 for couples sessions for each 50-minute session. If Therapist schedule allows it, a 90-minute Counseling Session (“Session”) can be arranged for a fee of $180.00 for individuals and $200 for couples. Additionally, if Therapist schedule allows it, a 70-minute Counseling Session (“Session”) can be arranged for a fee of $150.00 for individuals and $170 for couples. Payment is due 24-hours before the Session.

(b) Therapist shall also charge $30 per 15-minute increment for phone calls over 10 minutes in length which is due at the next scheduled Session or upon receipt of a statement. If the Client misses their scheduled appointment time, the Client will need to pay the remaining balance at the beginning of their next Session.

(c) Client shall understand that after they pay and book a Session it is mandatory that the client see therapist for the scheduled time that has been booked. If the Client fails to have their session with the Therapist on the day and time client has booked, the Clients funds will be forfeited and the Client will be required to pay in full if they choose to book another Session with the Therapist. 

(d) Client shall be encouraged to book 6 sessions in advance instead of 1 in order to gain maximum value from the Therapist.  If a Client chooses to book 6 Sessions in advance, they are required to pay upfront in full. If the Client chooses not to pay upfront, they will be required to split their payments into 2 or 3 installments. The installment payments will be automatically deducted from the account of the Client on the specific due date.

(e) Client shall understand if they choose to book 6 scheduled Sessions in advance, they have 8 weeks from the day of signing their Agreement to complete their 6 scheduled Sessions. In the event of an emergency, the Therapist shall give the Client 8 weeks to complete their 6 scheduled Sessions. The Client is not allowed to double up on Sessions, i.e., 2 Sessions in 2 hours or 2 Sessions in a week. The maximum number of Sessions the Counselor/Coach shall do is 1 a week with each Session being 50 minutes in length.

(f)Client shall understand they have the option of signing up for the 12 week Counseling Session. The 12 week Sessions will include a discounted rate of 5% when the Client pays upfront. The 12 week Counseling/Coaching Services will include 12 Sessions with the Counselor/Coach. Clients that are unable to pay upfront for the 12 week Sessions will have their payments automatically split into 4 installments. A Client under the installment payment plan will lose the 5% discount that is included in the 12 week Counseling/Coaching Sessions. Client has a maximum of 15 weeks in order to complete the 12 week Counseling/Coaching Sessions.

(g) Client shall make payments for their Sessions online via the website, Paypal or Zelle.

Therapist and Client Schedule the date and location of the Counseling Services as defined in this Agreement shall be performed as set forth with the Client. The Therapist shall perform the Services for the Client on the dates and times as agreed to. The Client shall also observe all holidays of the Therapist.

The Client and Therapist Relationship. The Parties understand that the Client- Therapist relationship is a partnership or alliance between the Client and the Therapist. This Therapist relationship is an alliance and not a legal relationship. The Client acknowledges and understands the Services of the Therapist is an inclusive and comprehensive process that may delve into certain areas of the Client’s personal life, including but not limited to, the Client’s life, relationships, career, education, recreation, fitness, and finances. The Client fully acknowledges that it is his or her ultimate personal decision as to how he or she decides to implement the Therapist, techniques, and advice into his or her life.

The Client must also acknowledge and understand that the Services rendered by the Therapist is not therapy and under no circumstances is it a substitute for therapy if needed. Furthermore, the Therapist does not diagnose, cure, prevent, or treat any mental disease or disorder.

Duties and Responsibilities of the Therapist. The Therapist and Client agree to uphold their respectful obligations under this Counseling Agreement. The parties acknowledge their responsibilities and duties under this Agreement are vital for the Client and Therapist relationship to be successful.

The Client agrees to stay in efficient and reasonable communication with the Therapist. The Client agrees to provide honest feedback to the Therapist and to be fully devoted and engaging in the Counseling program and respective services provided.

Duties and Responsibilities of Client. Client shall have the right to ask questions about any procedures used during the Sessions; if Client wishes, the Therapist will explain any approach and methods being used on the Client. If the Therapist sees a child under the age of 18, all custodial parents have the right to the information shared in the Session unless the Therapist determines that the sharing of such information would harm the child. If the Therapist determines this to be the case, Therapist would share such concerns with the custodial parent and outline all possible legal options.

Client shall have the right to decide not to receive assistance from the Therapist; if Client wishes, the Therapist will provide the Client with the names of other qualified professionals whose services the Client might prefer at a cost equal to or less than the Therapist own usual and customary fee.

Client shall have the right to end services at any time without any moral, legal, or financial obligations other than those already accrued. Therapist request the Client contacts the Therapist by phone if the Client wishes to make such a decision without consulting with Therapist.

Client shall have the right to review most of their records in the files at any time. If Client wishes to do so, the Client must ask in advance of their Session. The Therapist does not keep any "secret notes," so please do not ask the Therapist to do so. If a Client requests, any or part of their record in the files it can be released to any person or agency the Clients chooses to designate. The Client will be informed at the time whether or not the Therapist will release the information in question to that person or agency that might be harmful in any way to impact the Client.

Client shall be encouraged to ask questions. The Therapist is driven by curiosity. If the Client has any questions regarding questions about the Therapist pertaining to his qualifications, or anything not addressed in the previous paragraphs, it is the right of the Client to ask questions at any time. The Client can feel free to exercise this right.

Client must read and understand the information contained in the consent forms and the HIPPA brochure when appropriate. A signature to this Agreement will indicate that the Client has discussed any questions regarding the information contained in the HIPPA brochure with the Therapist. Furthermore, a signature to this Agreement will indicate the Client gives the full and informed consent to receive Services from the Therapist. This Agreement will also further indicate that the Client voluntarily agrees to receive and authorize the Therapist to provide Services that are considered necessary and advisable.

Consent to Treatment of Minor Child(ren): Client upon signing this Agreement hereby certify that they have the legal right to seek Therapist treatment for minors in their custody and give permission to the Therapist to provide treatment to the Clients minor child(ren). Client must understand that although they have a right to their child’s records, Therapist will waive his right to any records or disclosures, if, in the opinion of the Therapist, such disclosure could negatively impact the child or the child’s treatment. This Agreement shall hereby release the Therapist from any and all liability for good-faith refusal to disclose to the Client information about the child or the child’s records. The Client shall understand that except in rare circumstances, it is important for both parents to give consent for treatment. If the Client makes any unilateral decision-making capacity to obtain Therapist services for their child, the Client will provide the appropriate court documentation to the Therapist prior to or at the initial session. Otherwise, the Client will have his spouse or ex-spouse sign this consent for treatment form prior to the initial session

Cancellation Policy. Clients are responsible for attending each appointment agreed upon. However, the Therapist understands that, in certain circumstances, unexpected things can arise which can prevent the Client from being able to keep a scheduled appointment. Therefore, the Therapist adhere to the following policy:

(a) Client that is prevented from keeping a scheduled appointment, Therapist ask that the Client notifies the Counselor/Coach within 24 hours in advance so that another Client may have the opportunity to use that time slot. If Therapist does not receive 24-hour advance notice, the Client will be responsible for paying the full fee for the Session missed.

(b) Therapist will, from time to time, take time off for vacation, to attend seminars, and/or become ill. Psychotherapy is a uniquely personal service; therefore, consultations may be briefly interrupted. Therapist will attempt to give the Client adequate notice in advance and will arrange coverage for any emergencies by a colleague and/or crisis center.

Term and Termination. Therapist reserves the right to terminate in these instances:

(a) Therapist shall terminate if more than two Sessions are missed without proper notification

(b) Client that shall miss two scheduled Sessions in a row, will not be scheduled again until they pay their full remaining balance.

(c) This Counseling Agreement may be terminated at any time by mutual agreement by the Therapist and Client.

Confidentiality.  Any and all parties of this Contract, including all attachments hereto, shall be strictly construed and considered confidential in nature as follows:

(a) Client must understand confidentiality is not the same as privileged information. Within limits of the law, information revealed by you during counseling will be kept strictly confidential and will not be revealed to any other person or agency without the Clients written permission. Possible exceptions to confidentiality include court orders and the reporting of abuse or neglect, fee disputes, negligence suits against the Therapist, or the filing of a complaint with the licensing board. If the Client has a financial balance, the Client will be sent a bill to the home address on the intake form unless the Client advises the Therapist otherwise. Any confidentiality concerns should be discussed with the Therapist at the time they occur.

(b) Client must understand that neither the Therapist nor the Client shall have the right and entitlement to disclose any information and detail in relation to the Agreement and the Services herein represented and embodied. Such disclosure shall be considered a material breach of this Counseling Agreement and shall be subject to further action by the aggrieved party.

(c) Client must understand that the Counseling Services is not protected by legal confidentiality. Therefore, the Therapist may be required to disclose otherwise confidential information to authorities.

(d) Client must understand that there are certain situations in which Therapist is required by law to reveal information obtained during the Sessions to other persons or agencies without Clients’ permission. Also, Therapist is not required to inform the Client of the Therapist actions in this regard. These situations are as follows:

1. If a court of law issues a legitimate court order, the Therapist is required by law to provide the information specifically described in the order.

2. If Client reveals information relative to child abuse, child neglect, or elder abuse, the Therapist is required by law to report this to the appropriate authority.
If the Client are in a counseling Session by order of a court of law, the results of the treatment ordered must be revealed to the court.

(e) Client must undestand, if the Therapist is threaten grave bodily harm or death to the Client or another person, Therapist may choose to inform others, including (but not limited to) appropriate law enforcement and/or medical agencies.

(f) Client has the right to know about the possible risks of Therapist, which sometimes includes personal and relational discomfort and intense feelings (see below under RISKS).

Expectations: Work outside of the Sessions is a necessary element of change; therefore, the Counselor/Coach may ask the Client to perform some ‘homework’ related to Clients goals and or session content. The Therapist promises to work as efficiently as possible; at the same time, counseling may move more slowly than the Client anticipates. The Therapist will review Clients goals periodically and will ask that the Client request a conversation about the status of their counseling whenever they have questions about progress and/or length of treatment.

Risks: In working to achieve these potential benefits, the process will require that firm efforts be made to change and may involve the experiencing of discomfort. Resolving unpleasant events and relationship patterns can arouse intense feelings. Seeking to resolve problems can similarly lead to discomfort as well as relational changes that may not be originally intended. The Therapist and Client will work together for a desirable outcome; however, there is a possibility that the goals of Client will not be met. The Therapist will review the Clients progress at regular intervals and modify the treatment plan as needed. If progress does not occur in an agreeable manner, the Therapist may suggest a referral to a physician for a medical evaluation or to a different counselor.

Limited Liability. The Therapist makes no guarantees, warranties, or representations of any kind, express or implied with respect to the Services rendered and negotiated subject to this Agreement. In no event shall the Therapist be held liable to the Client for any special, direct, or consequential damages. Notwithstanding any damages that the Client may acquire, the Therapist under this Counseling Agreement, and the Client’s sole remedy, shall be limited to the amount paid by the Client to the Therapist under this Contract for all Services rendered throughout the duration of this Contract, including the date of termination. Client agrees that the Therapist is not responsible for any inaction or actions, or for any indirect or direct result(s) of any Services rendered by the Therapist.

Dispute Resolution and Governing Law. Parties (“Parties”) to this Agreement shall first attempt to settle any dispute through good-faith negotiation. If the dispute cannot be settled between the parties via negotiation, either Party may initiate mediation or binding arbitration in the State of Florida.

If the parties do not wish to mediate or arbitrate the dispute and litigation is necessary, this Agreement will be interpreted based on the laws of the State of Florida, without regard to the conflict of law provisions of such state. The Parties agree the dispute will be resolved in a court of competent jurisdiction in the State of Florida. This Agreement shall be binding upon the successors and assigns of the respective parties.

Ethical and Legal Matters: The Therapist has an ethical obligation to balance the interests of all Clients who become a part of this process. If the Client informs the Therapist of a situation that, in the Therapist opinion, is blatantly harmful, unfair, or illegal, the Therapist may, at his discretion, give Client the choice of correcting the situation when that is possible, informing other family members of the situation, having the Therapist tell them, or terminating counseling. In general, the Therapist will follow, to the best of his ability, all state laws and regulations as well as the policies and codes of ethics of the Florida Association of Marriage and Family Therapy (FAMFT) and the American Association for Marriage and Family Therapy (AAMFT). If the Client wishes to have a copy of these codes of ethics, please do not hesitate to ask the Counselor/Coach.

Counseling Relationship: The Therapist relationship with the Client is professional. In order to preserve this relationship, it is imperative that Parties do not have any relationship outside the Therapist relationship such as a friendship, business, or social relationship. The exchanging of gifts or bartering for services is not appropriate. If Parties have contact in a public setting, the Therapist will not acknowledge the Client in any way that would jeopardize the Clients confidentiality.

Legal Fees. Should a dispute between the named Parties lead to legal action, the prevailing Party shall be entitled to any reasonable legal fees, including, but not limited to attorneys’ fees.

Severability. If any term or provision of this Agreement is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this Agreement or invalidate or render unenforceable such term or provision in any other jurisdiction.

No Waiver. No waiver of or failure to act upon any of the provisions of this Agreement or any right or remedy arising under this Agreement shall be deemed or shall constitute a waiver of any other provisions, rights or remedies (whether similar or dissimilar).

Counterparts. This Agreement may be executed in counterparts, each of which shall be deemed an original, but all of which together shall be deemed to be one and the same agreement. A signed copy of this Agreement delivered by facsimile, email, or other means of electronic transmission shall be deemed to have the same legal effect as delivery of an original signed copy of this Agreement.

Electronic Communication Policy. This Agreement and related documents entered into in connection with this Agreement are signed when a Party’s signature is delivered electronically, and these signatures must be treated in all respects as having the same force and effect as original signatures. Clients shall also understand the following:

(a) Email offers an easy and convenient way for Therapist and Client to communicate, but can also introduce unique challenges into the Therapist–Client relationship. Below are some guidelines for contacting Therapist using e-mail. Do not use e-mail for emergencies. If it's an emergency, consult with an emergency room. E-mail is not a substitute for seeing the Therapist. If the Client thinks that they might need to be seen, please call and book an appointment. Appropriate use of e-mail also includes referrals and appointment scheduling requests.

(b) E-mails should not be used to communicate sensitive medical information such as information regarding sexually transmitted diseases, mental health, developmental disability, or substance abuse. E-mail is not confidential. Be aware that if Client sends e-mails from their work, their employer has the legal right to read Clients e-mail. E-mail is a part of Clients record. Either Client or the Therapist can revoke permission to use the e-mail system at any time.

(c) Further, texting also introduces some of the same challenges. Like e-mail, it is not a substitute for seeing Therapist or making an appointment. Because funds can be lost or stolen, it is imperative that the Client does not communicate information of sensitive in nature over a text. Texting may be used to request that Therapist call Client for scheduling purposes.

Captions for Convenience. All captions herein are for convenience or reference only and do not constitute part of this Agreement and shall not be deemed to limit or otherwise affect any of the provisions hereof.

Phone Contacts and Emergencies: Office hours are from 9:00am to 7:00pm Monday to Friday, and alternate Sundays from 2pm to 6pm. If Client needs to contact Therapist for any reason please contact Therapist at (954) 947-7425, leave a voicemail and Therapist will get back to the Client promptly. In emergency situations, Client can access emergency assistance by calling the National Suicide Prevention Lifeline at 1-800-273-8255.

Entire Agreement. This Agreement constitutes the sole and entire Agreement of the Parties regarding the subject matter contained herein, and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, regarding such subject matter. This Agreement may only be amended, modified, or supplemented by an agreement in writing signed by each Party hereto.