3 Session Loss and Grief Therapy

As a client of Dr. Harris, I understand that distance (online) counseling is provided via technology and there may be problems with phone and/or internet connectivity, which is neither the fault of Dr. Harris or myself.

Internet availability may be limited or disrupted by things such as server maintenance, upgrades, or other issues (such as software or hardware malfunction) or natural or man-made disasters (such as terrorist acts, Internet viruses, and so forth).

These types of problems are beyond the control of Dr. Harris and me (client). If something like this were to occur, any scheduled appointments would be re-scheduled.

I understand that at times, Dr. Harris may be legally required to violate confidentiality to make appropriate legal notifications if she reasonably believes I am: engaged in Intention to harm myself or others or child or elder abuse or neglect. This information will be addressed in the first session.

I realize that I will be charged a pre-arranged fee for services, which will be due prior to sessions. I understand that if I need to cancel a session less than 24-hour notice, I will be charged that fee.

As a client, I understand that I can end services at any time, for any reason, (with 24-hour notice), without explanation.

Although Dr. Harris has taken a significant number of steps to ensure the confidentiality and privacy of online or distance communication(s) between you and her, these actions, in whole or in part, cannot completely be 100% guaranteed regarding the security of internet transmissions.

I permanently agree to release and indemnify Dr. Harris from all suits, claims, and other actions originating from distance counseling.
By signing and checking the box below, you agree to the following consent form.