Therapy Contract Template

Disclaimer

The provided document serves as a general framework for establishing a therapeutic arrangement between practitioner and client. It is intended solely for informational purposes and does not replace legal advice. Customization may be necessary to ensure compliance with local laws and regulations. Users are responsible for reviewing and adapting the content accordingly. The creators bear no liability for any errors, omissions, or consequences resulting from the use of this template without professional consultation.

This example is a sample therapy contract and may slightly vary based on specific circumstances and legal requirements. Adjust details accordingly.

Therapy Contract Sample

Parties Involved:

Therapist: Dr. Jane Smith
Address: 789 Wellness Road, Suite 100, Springfield, IL 62704

Client: Alex Johnson
Address: 456 Maple Street, Springfield, IL 62704

Services Provided:

The therapist agrees to provide psychotherapy sessions aimed at mental health support and counseling, as outlined in this agreement.

Payment and Schedule:

The client agrees to pay a fee of $100 per session. Sessions are scheduled to occur weekly at a mutually agreed time. Payment is due at the end of each session via cash, check, or electronic transfer.

Confidentiality:

The therapist will maintain confidentiality in accordance with applicable laws and ethical guidelines, except where disclosure is required by law or in cases of risk to the client or others.

Term and Termination:

This agreement shall commence on __________________ and continue until either party terminates with written notice. Termination procedures and notice periods will be discussed during the initial sessions.

Additional Provisions:

• The client agrees to attend scheduled sessions and notify the therapist at least 24 hours in advance of cancellations.
• The therapist retains the right to terminate services if deemed appropriate for the client’s well-being.
• Any changes to this agreement must be documented in writing and signed by both parties.

Springfield, ______________________