Client Treatment Contract

By signing the following contract I consent to treatment and agree to the following:

I will be on time to sessions.  If I am unable to come to a session I will give 24 hours notice of my cancellation or I
will be charged for the missed appointment, not my insurance company.  I am aware of the office policy that if I do
not show for two appointments during the length of therapy I will be terminated as a client.

I will be open and honest about my situation even when the details are embarrassing because I understand that
this is a safe environment where I will not be judged and all the facts are needed to help me overcome the
problems that led me to seek therapy.  I will voice my goals and my desired direction for therapy.  I understand
that I can talk to my therapist if I feel we are not on the path to achieving my goals.

If I would like to terminate or stop therapy I understand that I need to share these feelings with my therapist.  This
can be done in person, by phone or in writing.  Our common goal is to resolve my problems, whether that is with
this therapist or another.  If I do not feel comfortable with my therapist, they will make every effort to find me
another therapist that will serve my needs.  I understand I have the right to refuse or negotiate modification of
any suggestions that I believe to be harmful.  At any time I can initiate discussion of possible positive or negative
effects of entering or not entering counseling, continuing or not continuing counseling and or using certain
techniques.  I am aware that it is not unusual as the counseling process progresses that I may feel things are
getting worse before they get better.  I understand that results cannot be guaranteed.  I will make every effort to
complete the homework assignments.  I understand that talking alone will not completely solve my problems.   I
know that I need to seriously approach assignments and work hard inside and outside therapy.  I understand my
unwillingness to work on the tasks agreed upon could result in my termination as a client.

I will use email for non-emergent communication and I will not abuse it by sending chain mail or non-therapy
related communication.  (Email will be responded to usually within 3-5 days.)  I will also refrain from seeking my
therapist via social networking sites such as facebook or myspace.   

I will not come to sessions while under the influence of drugs or alcohol.  I understand that I will not be seen for
my session and I will be charged for the missed appointment.  I also understand that if I or my guests coming with
me to The Therapy Place damage or destroy property I will be held financially responsible.  This includes the
pulling of fire alarms.  You will be charged $500.00 for each alarm pull that is a false alarm.

If I have suicidal or homicidal thoughts while I am in treatment at The Therapy Place I understand it is my
responsibility to tell my therapist about these thoughts immediately.  I will disclose these feelings at the beginning
of the session.  If I have these thoughts outside of therapy I will contact my therapist, or have someone take me
to the nearest emergency room or dial 911.  I also understand that I will be terminated immediately as a client
should I become verbally, sexually, or physically aggressive toward my therapist.

I have had any additional questions answered and this document explained to me.  Signing below indicates that I
am in agreement with these regulations.

__________________________________        ________________________________        
Client Name                                                         Parent/Guardian Name

__________________________________        ________________________________                
Client Signature                                                   Parent/Guardian Signature

Date: ____/____/____                                Date: ____/_____/______        





                                                          
Therapist Treatment Agreement

I agree to meet with clients in scheduled sessions to aid them in overcoming problems.  Please carefully read the
privacy notices for regulations regarding the privacy of your health care information.

I agree to only work within my scope of practice.  I will treat only those issues that I have competence, education,
training and professional experience.  I will continue to develop my skills through ongoing education in order to
maintain a high level of performance.

I will treat clients with respect and be aware of individual differences, cultural and ethnic diversity.  I will work with
clients as a partner in the helping process to promote, restore, maintain and enhance the client’s well being.  My
desire is to promote the client’s ability to make decisions and help them clarify goals.  Please note that it is
impossible to guarantee results regarding your goals.

I am unable to have outside relationships with those who are currently or have in the past required my care.  This
means that I am unable to be friends or have social contact with clients outside of therapy.  If we were to see
each other in public I will not acknowledge you because I feel this is a breech of confidentiality. I am also unable
to accept goods or services in exchange for providing therapy.  This may yield inappropriate boundaries and
destroy the therapeutic relationship.

In the event that I am unable to continue treatment due to illness, relocation, disability or death, I will make every
effort to make sure clients are able to continue with another therapist.  I will also give you notice of any extended
vacation that may interrupt service for more than one week.

If for some reason you are dissatisfied with my services, please let me know.  A referral can easily be made if
needed.  A verbal exploration of alternatives will be provided upon your request.  If you have a complaint which
you believe needs to be registered with my governing board you can contact North Carolina Board.


____________________________                        ______________
Therapist                                                                  Date

By signing below I acknowledge that I have been given the opportunity to ask questions and I agree with and
understand the above document.

_________________________________        __________________________________
Client Name                                                       Parent/Guardian  Name                   

_________________________________        __________________________________
Client Signature                                                Parent/Guardian Signature

Date:  ____/____/_____                                Date:  ____/____/_____















                                                  Marital Therapy Contract


I will not subpoena the records from our marriage counseling sessions or summon my therapist to court.   I
understand this applies to divorce and custody proceedings.  I recognize that this needs to be an environment
where all parties can be honest and open about the situation.  This is a pledge that the purpose of our meetings
will be to save the marriage or to end the marriage by peaceful means without the fear of future repercussions
and manipulation of the truth through litigation.



I have read and understood the above contract.  By signing below I am indicating that I will comply with these
terms.



________________________________            _______________
Spouse                                                                Date




_________________________________          _________________
Spouse                                                                Date




_________________________________           __________________
Therapist                                                              Date