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In Brief

Are you experiencing distress? No need to go through this alone. Barbara Sanders, LCSW, is an experienced, licensed psychotherapist who is committed to helping her clients work through whatever issues are creating difficultes. With her assistance, you can live a healthier, more satifying life, moving from stress to hope and from problems to solutions.

Psychotherapy can help you develop successful new ways to cope and heal, learn how to handle stress more effectively, and find more pleasure and satisfaction in life.

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 Initial Agreement for Psychotherapy, Coaching, Mediation, and Evaluation Services

 

  1. I agree to use the services of Barbara Sanders, LCSW.
  2. For Psychotherapy, counseling or integration services, I understand that Ms. Sanders will meet with the client for 45 minute sessions (unless more time is agreed upon), and that she will expect payment at each session.
  3. I understand that my therapy or other services are confidential unless there is an emergency, or a release of information form has been signed by the client.
  4. The cost for Psychotherapy services is $150 per 45 minute session. If Ms. Sanders bills my insurance, I am responsible for the full fee at each session and will allow the insurance company to pay me my benefits.
  5. For Mediation services, I understand that the charge is $200 per hour for Ms. Sanders' work, including but not limited to face-to-face sessions, research, administrative work, and writing reports. Ms. Sanders will not charge insurance companies for these services because they are not related to diagnosis and treatment.
  6. For Breathwork sessions, I understand that my change is $250 per hour.

 

Name of the Client(s):__________________________________________________________________

 

Signature of Client(s)___________________________________________________________________

 

Other responsible party, if needed __________________________________________________________

  

Date________________Signature of Provider___________________________________________