Client/Practitioner Agreement

  • Request
  • Ethical
  • Scope
  • Names
  • Conditions

Please complete this form together

We/I have requested the relationship couple session(s).

I have confirmed our booking by making payment by internet banking.

Confidentiality (Keeping things private)

We will aspire to hold to the iAMFC Code of Ethics. I consent to this.

All we discuss is confidential with the a few exceptions as listed in the disclosure document at https://rocksolidrelationships.nz/disclosure-statement/. I consent to this.

Scope of Practice

I have read the Scope of Practice, at https://rocksolidrelationships.nz/scope-of-practice/ , and I consent to the scope of practice provided by The Practitioner including their specific focus on relationships between couples.

I have read the Disclosure Statement at https://rocksolidrelationships.nz/disclosure-statement/ and agree to this

Partner 1

First name

Last Name

email

Phone

Partner 2

First name

Last name

email

Phone

Address

Number & street

Suburb

City

Conditions

Rock Solid Relationships requires 48 hours notice when rescheduling or cancelling appointments. Bookings changed within the notice period will incur a fee of 1/2 the session rate. All non-attendance will incur the full fee and you will be invoiced. Thank you for respecting these conditions when booking your appointment.

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