New Client Financial Agreement

 
Name *
Name
Address
Address
Phone *
Phone
Pricing Packages *
Fees *
I, the client, understand and accept that… 1. Couples Coaching Special Rate @ $95 x One (1) forty-five (45) minute session (in-person/online) = $95 2. There is a service fee of $3 for each therapy/coaching session. 3. Payment must be made in advance of all scheduled therapy/coaching sessions. 4. Payment must be made online using a credit or debit card.
Cancelation and Rescheduling *
I, the client, understand and accept that… 1. If I need to reschedule/cancel a therapy/coaching session, I must provide at least 24-hours’ notice. 2. If I fail to provide at least 24-hours’ notice, I will be charged the full session fee.
Refund Policy *
I, the client, understand and accept that… 1. There are no refunds once services have been rendered.
Terms *
As a therapy/coaching client, I understand and agree that I am completely responsible for my well-being during my time in therapy/coaching. This includes my choices and decisions. No guarantees have been made to me as to the expected outcome of my therapy/coaching. I am aware that I can choose to discontinue therapy/coaching at any time. ** For Coaching Clients ONLY - I recognize that coaching is a process, and it is not psychotherapy. A professional referral is given if it appears psychotherapy is needed.
Today's Date *
Today's Date