Agreement Agreement This agreement made this: * Checkboxes I understand and agree that this is a guidance service and it is not is NOT therapy. I understand and agree that there will not be a diagnosis, no billing of insurance, no notes that could be used or called into question at a later date. I understand and agree that the guide will not be retaining records or notes regarding our interactions. I understand and agree that my interactions with this guide are confidential and are only for the purpose of my own personal growth. I understand and agree that I will show up for my scheduled sessions and will give my guide 24 hours notice if I need to make changes. I understand and agree that if I do not show up for my session, or give less than 24 hours notice that there will be no refund. I understand and agree that I am responsible to pay the fee for the session at the time of scheduling. I understand and agree that if I give 24 plus hour notice for rescheduling, the fees paid will be used towards the new session. I understand and agree that if I am experiencing a mental health crisis and need a higher level of services, I will call my local emergency services. Signatures Name of Client * Name of Client First First Last Last Date signed * Signature Upload * Drop a file here or click to upload Choose File Maximum file size: 516MB If you are human, leave this field blank. Submit Start Over
