Consent for Treatment
I, hereby consent to participate in individual therapy with Jennifer York, a Licensed Marriage and Family Therapist (LMFT). I understand that the purpose of therapy is to help me address and resolve the issues and concerns that I bring to the sessions.
Nature of Therapy
I understand that therapy involves discussing personal issues and feelings, which may at times be distressing.
Therapy aims to provide support, enhance personal growth, and help in resolving the issues I choose to address.
The outcome of therapy is not guaranteed, as it depends on various factors, including my effort, consistency, and openness.
Confidentiality
I understand that information shared in therapy is confidential and will not be disclosed without my written consent, except in the following situations:
If I am a danger to myself or others.
If there is suspected abuse or neglect of a child, elder, or dependent adult.
If a court order is issued for the release of records.
Session Details
Each session lasts approximately 50 minutes.
The fee for each session is equal to the booking cost shown on the appointment scheduler. Payment is expected at the time of service unless otherwise agreed upon.
Cancellations must be made at least 24 hours in advance to avoid a cancellation fee.
Risks and Benefits
I understand that there are potential benefits and risks to therapy. Benefits may include better emotional regulation, improved relationships, and greater insight. Risks may include experiencing uncomfortable emotions or recalling difficult memories.
Termination of Therapy
I understand that I have the right to terminate therapy at any time. However, it is recommended that we discuss termination to ensure closure and address any remaining concerns.
Emergency Situations
I understand that my therapist is not available 24/7. In case of an emergency, I will contact emergency services or go to the nearest emergency room.
Client Acknowledgment and Agreement
I have read and understood the information in this consent form. I have had the opportunity to ask questions, and I agree to the terms of therapy.
