This document serves as a legally binding contract ("Contract") between [YOUR NAME], hereinafter referred to as the "Provider," and [Client Name], hereinafter referred to as the "Client," outlining the terms and conditions of the professional relationship. By signing this Contract, both parties agree to abide by the terms herein.
The Provider agrees to offer social work services to the Client, including the following:
Individual counseling sessions.
Group therapy sessions.
Case management services.
Advocacy on behalf of the Client.
Referral to other resources and support networks.
The specific services to be provided will be discussed and agreed upon during the initial assessment session. This may include setting treatment goals, establishing a therapy schedule, and outlining the methods and techniques to be used.
The Provider will utilize evidence-based practices and adhere to professional standards in delivering services to the Client.
The Provider will maintain confidentiality by applicable laws and professional ethics.
The Provider will professionally conduct sessions, respecting the Client's autonomy, dignity, and cultural background.
The Provider will regularly assess the progress of the Client and adjust the treatment plan as necessary.
The Client agrees to actively participate in the therapy process, including
attending scheduled sessions and completing assigned tasks or homework.
The Client agrees to provide accurate and honest information to the Provider to facilitate effective treatment.
The Client understands that the success of therapy depends on their commitment and effort.
The Client agrees to pay the Provider the agreed-upon fee of $100 for each therapy session, payable at the time of service. The fee structure will be discussed and agreed upon during the initial session.
Fees for missed appointments or late cancellations may apply. The Client will be notified of the Provider's cancellation policy, which may include a fee equivalent to the session rate for appointments canceled with less than 24 hours notice.
Payment methods accepted by the Provider include cash, check, credit/debit cards, or electronic transfer. Payment is due at the time of service unless prior arrangements have been made.
The Provider will maintain strict confidentiality regarding all information shared by the Client during therapy sessions, including discussions, records, and personal data, by applicable laws and professional ethics.
The Client understands that confidentiality may be breached in situations involving:
Imminent risk of harm to self or others.
Suspected child abuse or neglect.
Court-ordered disclosure.
Written consent was provided by the Client for the release of information to specific parties.
Services may be terminated by either party, but this can only be done by providing written notice to the other party involved.
The Provider holds the power and liberty to bring the services to a halt, should there be a judgment that continuation of the therapeutic procedures would be unfitting or unsuitable, or if it has been found that they are not producing the expected benefits or results.
In the event of a dispute arising under this Contract, both parties agree to attempt to resolve the matter amicably through negotiation and mediation. A neutral third party may be involved to facilitate discussions and reach a resolution.
If mediation fails to resolve the dispute, the matter shall be referred to arbitration by the laws of [Jurisdiction]. The decision of the arbitrator(s) shall be final and binding on both parties.
The administration, interpretation, and any related actions regarding this Contract will fall under and be influenced by the legal regulations and laws about [Jurisdiction].
This Contract constitutes the entire agreement between the Provider and the Client, superseding any prior contracts or understandings, whether written or oral.
Any modification to this Contract must be made in writing and signed by both parties.
If any provision of this Contract is found to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.
By signing below, the parties acknowledge that they have read and understood the terms of this Contract and agree to be bound by them.
[YOUR NAME] (Provider)
[DATE SIGNED]
[CLIENT'S NAME] (Client)
[DATE SIGNED]
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