• Confidentiality
  • Scope
  • Terms
  • Name
  • Address

Consent

All we discuss is confidential. We consent to the exceptions of (1) supervision and (2) our safety.

Session Notes

What do you want to happen to your session notes?

Scope of Practice

I have read the 'Scope of Practice' and the 'Disclosure Statement' on the website.

Terms

I agree to give 24 hours notice when rescheduling or cancelling appointments.

Late cancellations, non-attendance, and rescheduling within 24 hours of the session time are charged at 40% of the session rate.

I agree to these terms and conditions for rescheduling, late cancelling and non-attendance.

Partner 1

First-Name & Last-Name

email

Phone

Partner 2

First-Name & Last-Name

email

Phone

Address

Number & street

Suburb

City