Consent for Individual Therapy Services
Please read the following information carefully. By completing and signing this form, you acknowledge your understanding and agreement to participate in therapy services.
1. Nature and Scope of Therapy
Therapy is a collaborative process that involves exploring emotional, behavioral, relational, and psychological challenges. Sessions are typically 50 minutes in length unless otherwise arranged.
2. Confidentiality
Information you share in therapy is confidential and will not be disclosed without your written consent, except as required by law. Legal exceptions include:
Suspected abuse or neglect of a child, dependent adult, or elder
Threats of harm to self or others
Court orders or legal mandates
3. Fees and Payments
Session fees are due at the time of service unless other arrangements are made. Payment methods and package options are available on the website.
To support clarity and meet California’s guidelines for price transparency, we’ll use our first 1–3 sessions to get to know each other and begin outlining a course of therapy or coaching tailored to your needs. During this time, we’ll collaboratively identify your goals and establish an estimated timeline for our work—typically between 3-6 months, and for some up to a year or more. While every journey is unique, this gives you a clear sense of what to expect, including the potential number of sessions and overall investment.
4. Cancellations and No-Shows
A minimum of 24 hours’ notice is required to cancel or reschedule a session. Cancellations made with less than 24 hours’ notice, or no-shows, may be charged the full session fee, except in cases of emergency at the provider’s discretion.
5. Records and Communication
Session notes are securely maintained in accordance with California law. Email and text messaging are not secure for sharing confidential information and should be used only for administrative purposes such as scheduling.
6. Consent to Treatment
By signing this form, you affirm that you understand and agree to the terms of service and voluntarily consent to receive individual therapy.
7. Practice Values and Scope
I work with individuals across diverse identities, life stages, and cultural backgrounds. Whether you're navigating trauma, anxiety, relationship issues, parenting stress, or burnout, I strive to provide a grounded and compassionate space where healing, growth, and self-discovery can unfold at your own pace.
As part of my ethical and clinical standards, I provide Emotional Support Animal (ESA) letters and attendance verification only when therapeutically appropriate. I do not provide documentation for family court, child custody, or other legal proceedings.
My work is rooted in safety, trust, and accountability—so you can reconnect with your strengths and move toward emotional balance, resilience, and meaningful growth.
