And seeks your consent ... I agree to give 4 hours notice when rescheduling or cancelling appointments.
I agree that late cancellations, missing my appointment, not showing up, or rescheduling within 4 hours of the session time is deemed a chargable at 40% of the session rate.
This offers transparency around how I work
Please complete this form together
We/I have requested the relationship couple session(s).
Confidentiality (Keeping things private)
All we discuss is confidential. We consent to the exceptions as listed in the disclosure document to allow for supervision and safety https://rocksolidrelationships.nz/disclosure-statement/.
Scope of Practice
I have read, and agree to, the Scope of Practice, at https://rocksolidrelationships.nz/scope-of-practice/ , and I consent to the scope of practice provided by The Practitioner.
I have read and understand 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
Booking
I understand and agree to conditions for rescheduling, late cancelling and non-attendance.
