Sharon Lotoczky LMSW
CONSENT FOR COUNSELING SERVICES
I am voluntarily seeking services which may include: an initial assessment, counseling or coaching.
I am aware that:
- No promises or guarantees shall given to me concerning these services.
- The goal plan shall be developed with my understanding and approval.
- Termination is usually an agreement between the therapist/counselor and myself. Termination may be initiated by the therapist/counselor for any inappropriate communication.
- It may be inappropriate to conduct phone sessions or email follow up from client's place of employment.
I agree to:
- Pay my fee of $85.00 per hour at the time of the appointment.
- Pay a no show/late cancellation fee of $85.00.
- Keep my scheduled appointments or provide 24 hour notice of a cancellation.
- Be responsible for maintaining a secure computer system.
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