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New Client Agreement
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New Client Agreement
THIS AGREEMENT made at
on this date of
Between (The client)
And (The consultant)
Fees:Fees are payable at the time of the consultation. Payments may be made by Wires, MasterCard, Visa, PayPal or cash. If our reception is unattended at the time of your consultation an invoice will be emailed to you. The terms for payment of these invoices is seven days net.
Cancellation PolicyWe require 24 hours notice of any need to change or cancel an appointment. An administrative fee of $120.00 will be charged for non-attendance or cancellation with less than 24 hours notice.
ConfidentialityAll personal information gathered by the Psychologist during the provision of the psychological service will remain confidential and secure, except when:It is subpoenaed by a court; orFailure to disclose the information would place you or another person at risk; orYour prior approval has been obtained to:provide a written report to another professional or agency (e.g., a GP or a lawyer); or todiscuss the material with another person (e.g. a parent or employer)
The Agreement by completing the fields below, including the signature, you understand and agree to the conditions for the services provided by your Psychologist(s), including the Cancellation Policy.
Email
Mobile Number
Signature
Today's Date
