The following document is intended to form an agreement for a professional Counseling relationship between the two parties listed below. Failure to adhere to the agreed contract by either party may lead to the termination of the agreement. This contract is subject to re-negotiation at any stage of the working relationship by agreement of both.
*Please print this page and fill it out
COUNSELING CONTRACT BETWEEN Arleigh M. Hegarty (Counselor)
CLIENT’S CONTACT DETAILS
___________________________________________ Zip Code: ______________________
Home Phone: ______________________________ Mobile: _________________________
E-mail address: ___________________________________________________________
PRIMARY CARE PHYSICIAN __________________________________________________
_________________________________________ Zip Code: _______________________
There is no charge for a one hour initial session in which both the counselor and client will evaluate whether counseling at TCCM is the best fit for all involved. Subsequent sessions, whether individual or couples, are $50.00 per session. In the case of extreme hardship this fee may negotiated.
METHOD OF PAYMENT:
Payments, by cash or check, will be made at each session. It is also possible to arrange billing on a monthly basis in advance. Outstanding balances beyond 60 days will result in a termination of counseling sessions until the balance is paid. Checks should be made payable to Tri County Compass Ministries.
SCHEDULE OF SESSIONS
Frequency: Once weekly
Day of Week: ____________________________ Time: ______________________________
Length of Session: One Hour
First Session will begin on _______________________________________________________
Final Session will be determined by the counselor and counselee based on the progress made.
Missed Appointments: billable at the regular fee.
Late Arrival: It is expected that the session will begin at the agreed upon time. Any session that begins after this time, due to late arrival for whatever reason, cannot be extended beyond the agreed finish time.
Confidentiality is important to Biblical counseling because growth occurs best in an atmosphere of mutual trust.
There are times, however, when the Bible forbids a counselor to hold back information. Therefore, we practice a policy of CONFIDENTIALITY WITHIN BIBLICAL LIMITS. We promise, in accord with the Scriptures, to keep all counseling matters confidential except:
1. Situations where a civil law has been broken, and the counselee is not willing on his own initiative to make things right. We cannot promise to keep serious matters from the civil authorities ordained by God (Romans 13: 1-7).
2. Situations where a Christian counselee repeatedly refuses to deal with personal rebellion against God. Being sinners ourselves, we are very patient with others struggling with sins and lifestyles that are displeasing to God. But if a counselee gives up the struggle and surrenders himself to persistent disobedience to God, consultation with your pastor or church leadership may become necessary (Matthew 18:15-25 and 1 Corinthians 5: 1-5).
In either of the above statements, we will bring others into the situation only slowly, with the prior knowledge of the counselee, and only after genuine attempts to have the counselee deal with the issues himself, privately.