Counseling Services Agreement Form
Please complete this agreement to confirm your understanding of our counseling services, session details, and policies.
Client Full Name
*
First Name
Last Name
Counselor Full Name
*
First Name
Last Name
Service Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Session Frequency
*
Please Select
Weekly
Bi-weekly
Monthly
Other
Preferred Communication Method
*
Please Select
In-person
Video call
Phone call
Other
Session Duration (minutes)
*
Session Fee Acknowledgment
*
I acknowledge the session fee and payment terms.
Cancellation Policy Acknowledgment
*
I have read and understand the cancellation policy.
Emergency Contact Name & Phone
*
Signature (Type your full name as agreement)
*
Submit Agreement
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