Free Treatment Agreement

This Treatment Agreement ("Agreement") is entered into on [DATE] between [YOUR NAME], hereinafter referred to as "Therapist", and [CLIENT'S NAME], hereinafter referred to as "Client".

Section 1: Scope of Services

The Therapist agrees to provide the following services to the Client:

a) Individual therapy sessions focused on cognitive-behavioral techniques for managing anxiety and depression.

b) Monthly progress assessments to track treatment goals and outcomes.

Section 2: Responsibilities of the Therapist

2.1 Therapist Obligations:

a) Provide professional and competent services by applicable laws and ethical standards.

b) Maintain confidentiality of all information disclosed by the Client during therapy, except as required by law or with the Client's written consent.

c) Respect the Client's autonomy and right to make informed decisions regarding their treatment.

d) Maintain appropriate boundaries and avoid any form of dual relationships that could compromise the therapeutic process.

Section 3: Responsibilities of the Client

3.1 Client Obligations:

a) Attend scheduled therapy sessions promptly and notify the Therapist in advance of any cancellations or rescheduling requests.

b) Participate actively and honestly in the therapy process, including providing accurate and relevant information to the Therapist.

c) Respect the confidentiality of other clients and refrain from disclosing any confidential information shared by other clients during group therapy sessions.

d) Engage in homework assignments or exercises recommended by the Therapist to support the therapeutic goals.

Section 4: Payment Terms

4.1 Fee Structure

The client has given their consent and agreed to provide payment to the therapist, a sum that was previously determined and agreed upon between both parties, which is $100 for every therapy session. This agreed sum and payment plan are detailed in the fee schedule that is issued and provided by the therapist.

4.2 Payment Schedule

Payment is due at the time of service unless alternative arrangements have been made in advance.

4.3 Cancellation Policy

The Client acknowledges that missed or canceled sessions without 24 hours' notice may be subject to a cancellation fee of $50.

Section 5: Confidentiality

5.1 Confidentiality Agreement

The Therapist agrees to maintain the confidentiality of all information shared by the Client during the course of therapy, except as required by law or with the Client's written consent.

5.2 Exceptions to Confidentiality

The Client acknowledges that confidentiality cannot be guaranteed in certain situations, such as instances where there is a risk of harm to self or others, or when required by law.

Section 6: Termination of Services

6.1 Termination Clause

Either party may terminate this Agreement at any time by providing written notice to the other party.

6.2 Termination by Therapist

The Therapist reserves the right to terminate services if the Client fails to comply with the terms of this Agreement or if continued therapy is deemed not clinically appropriate.

6.3 Termination by Client

The Client acknowledges that termination of services may be necessary if the therapeutic goals have been achieved or if the Client no longer requires therapy.

Section 7: Dispute Resolution

7.1 Dispute Process

Any disputes arising out of or relating to this Agreement shall be resolved through negotiation and mediation, to reach a mutually acceptable solution.

7.2 Mediation Procedure

If mediation is unsuccessful, the parties agree to submit the dispute to binding arbitration in accordance with the rules and procedures of [Arbitration Organization].

Section 8: Amendments

This Agreement, for any changes, modifications, or amendments to be sanctioned and considered valid, it is required that these changes can only be made in a written form. Furthermore, these changes in writing must also bear the signatures of both parties involved, thereby indicating their explicit consent and agreement to these changes.

Section 9: Governing Law

This Agreement, in all aspects, will be interpreted, understood, and managed in accordance with the laws as established and practiced within the jurisdiction of the State of California.

Section 10: Entire Agreement

This Agreement constitutes the entire understanding between the parties and supersedes all prior agreements and understandings, whether written or oral, relating to the subject matter herein.

IN WITNESS WHEREOF, the parties have executed this Agreement as of the date first above written.

[YOUR NAME] (Therapist)

[DATE SIGNED]

[CLIENT'S NAME] (Client)

[DATE SIGNED]

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