I. Overview

This is a treatment agreement between the Client and the Therapist, Sandra Anne Landers, LCSW, thereafter referred to as the Client and the Therapist or the Parties.

1. The Client agrees to provide pre-session identifying information and to provide emergency contact information in the event of an emergency.

2. The Client agrees to seek care at the nearest emergency room in the event of an emergency and in acknowledgement of the limitations of the electronic format and geographic time zones which may limit the immediate accessibility of the Therapist.

3. The Client agrees to follow and complete the therapeutic tasks and assignments provided by the Therapist in achieving treatment goals.

4. The Client agrees to provide 12 hour notice of delay or termination of appointments to the Therapist with the understanding that a charge for the time reserved will be incurred without such notice.

5. The Client agrees to prepayment of service following the scheduling of each session and prior to the beginning of each scheduled session.

6. The Parties agree that a session will begin with the Client's first encrypted email to the Therapist ( which does not include pre-session identifying information and clarification email ) and a session will end upon the Therapist's response email to the Client's email.

7. The Parties agree that it may be necessary for the Therapist to respond to the Client's email in more than one email due to the length and that a second response email begins a new session for which prepayment would be required.

8. The Parties agree that in the event of technological failure during a session that an alternative session may be arranged or an alternative means of contact made as appropriate.

9. The Parties agree to discuss the duration of treatment in accordance with the completion of treatment goals and the Therapist’s assessment of the Client’s continued need.

II. Confidentiality

1. The Parties agree that information or communication discussed and/or provided is deemed confidential to safeguard the rights of the Parties and maintain the therapeutic environment.

2. The Client agrees that the Therapist is bound by the standards of care and code of ethics in the state/region in which the Therapist is licensed and as such, the following exceptions apply.

3. The Parties agree that confidentiality may be waived if the Client provides written permission.

4. The Parties agree that under Florida Statute 491.0147 “ when there is a clear and immediate probability of physical harm to…the client, to other individuals, or to society..” this agreement of confidentiality may be waived by the Therapist.

III. Issues of Concern

1. The Client agrees that though the benefits of counseling often outweigh such risks, that the condition for which it was sought may not change and may not improve with or without such benefits.

2. The Client agrees that in some jurisdictions, the delivery of service is deemed to take place at the geographic location of the Client and therefore in the event of complaint, the Client may or may not find recourse with the licensing board which governs the Therapist’s practice.

The Client agrees that he/she has read, understands and accepts the above listed terms of agreement for counseling.

I Accept

I Decline