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.

Now offering on-site workshops for parents, couples and women in transition.


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