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Missed Session / Late Cancellation Policy
When a session is cancelled without adequate notice, we are unable to fill this time slot by offering it to another current client, a client on the wait list, or a client with a clinical emergency. With that in mind, the cancellation/rescheduling/missed session policy is as follows:
• With at least
24 hours notice,
sessions can be cancelled or rescheduled free of charge.
• Cancelled, rescheduled, or missed sessions that were not done so with 24 hours notice are considered lost time and cannot be made up, thus the full session fee is charged. The only exception to this is an extreme emergency.
• In cases where a session is cancelled by us, you will be given the option of credit for another session or a refund.
Please initial indicating that you have read and understood this section:
*
Telephone Calls and Messaging:
❖ You can use the email address to communicate with me. I will respond to your message as soon as possible, generally within 24 hours.
❖ If you are experiencing an emergency episode, please call
911
or a
Crisis Hotline
such as:
Suicide Hotline: 1-800-784-2433.
Dialing
211
on your phone will bring you to a national human service call center.
BY ENTERING MY NAME BELOW, I AM INDICATING MY INTENT TO ELECTRONICALLY SIGN THIS AGREEMENT AND I REPRESENT THAT BY SUBMITTING THIS DOCUMENT I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD ALL TERMS HEREIN.
Client (or Guardian) Signature:
*
Date
*
MM slash DD slash YYYY
Client (or Guardian) Signature:
Date
MM slash DD slash YYYY
Please Email a copy to me.
Yes, please send me a copy.
No, thank you.
Email
Phone
This field is for validation purposes and should be left unchanged.
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