Service Agreement
All clients are required to complete this service agreement, prior to the start of our session. Please do not submit this form without booking a session on Calendly, first.
General Terms and Conditions
You as the client,
a) May ask questions on what to expect at any time during the sessions.
b) May decline to proceed with the sessions at any time.
c) May cease to continue the sessions at any time, without any impediment and may return to the sessions at any time.
d) Have the right to review his/her own records as kept by the facilitator.
e) Can raise concerns and to discuss any of these concerns with the facilitator, provided that the facilitator is likewise available for discussion.
f) Must be paid up in full for a session, 24 hours before starting the session.
g) Have to take notice that, in case of non-regression, the session will not be refunded.
Payments, Cancelations, etc.
j) If you cancel as session in progress at any time, you will be charged for the full session.
i) If you fail to cancel any session within a 24 hour window before the start of the session, you will be charged for the session.
j) The facilitator holds the right to dismiss you, as the client, from the course of sessions without prior notice.
k Right to confidentiality: Within limits provided for by law, all records and information acquired by the facilitator shall be kept strictly confidentiality, in accordance to the principles of a facilitator-client relationship. No information will be shared or revealed to any person, agency, or organization without the prior written consent of you as the client, with exception of legal obligation as put forth in the confidentiality agreement.
l) Indemnity: The client shall indemnify and hold harmless the practice (and its subsidiaries, affiliates, officers, agents, co- branders or other partners, and employees) from any and all claims, damages, liabilities, costs, and expenses (including, but not limited to, reasonable legal fees and all related costs and expenses) incurred by the practise as a result of any claim, judgment, or adjudication against the practice related to or arising from regression sessions and/or any visits to the practice’s property.
Exceptions to Confidentiality
There are exceptions to confidentiality that you should know about. Please note that while most of these situations are rare, they are important for you to understand. Exceptions to confidentiality include, but are not limited to, the following:
1. If you threaten to harm someone else, I am required under the law to take steps to inform the intended victim and appropriate law enforcement agencies.
2. If you threaten to cause severe harm to yourself, I am permitted to reveal information to others if I believe it is necessary to prevent the threatened harm.
3. If you reveal or I have reasonable suspicion that any child, elderly person, or incompetent person is being abused or neglected, the law requires that I report this to the appropriate county agency.
4. If a court of law orders me to release information, I am required to provide that specific information to the court.
5. If you are or become involved in any kind of lawsuit or administrative procedure where the issue of your mental health is involved, you may not be able to keep your records or therapy private in court.