LIFE SKILLS PLUS, INC.

Earl Friesen, M.A., LMFT


 

Dear Client:


 

I want to take this time to personally thank you for choosing me as your therapist.  I hope I can help you in your personal and relationship growth process.  I have included some of the material in the treatment agreement for your convenience.  If you want a complete copy of the agreement, I will provide you a hard copy or you can go online to my web site and read or print it there under forms.


 

APPOINTMENTS

If you need to contact me before the next session, you may call me and leave a message at (719) 471-1225.

You are expected to remember your next appointment date.  My cell phone is for life threatening emergencies only.

Please remember that any appointment that cannot be kept must be canceled 24 hours in advance or the normal charges will be applied.  If you are unable to come in on a snow day, you should call in as soon as possible and the 24 hour rule will not apply.  Clients that fail to show for sessions repeatedly over a period of time will be terminated.  Medicaid clients cannot be billed for misses session, therefore, medicaid clients who miss two appointments without 24 hour notice will be terminated.  


 

FEES

My fee is $150.00 per session.   If you need a letter written, the normal fee amount will be charged for the time it takes to write the letter.  Insurance will not cover this cost.  Initial sessions are $175.00.  I do not do any court work, such as testifying in custody cases, in my practice.


 

CONFIDENTIALITY

The law, professional ethics, and common sense require that information revealed during session not be shared with anyone else without your written permission.  Exceptions; First: I keep notes that in rare conditions may be subpoenaed and I may be obligated to surrender them.  This would be done only with your knowledge.  Second: If you indicate that you intend to injure or take the life of yourself or another, I must act to notify potential helpers or victims.  Third: If you report that you are currently the perpetrator or victim of child abuse or molestation, I am obligated to report it to the proper authorities.  Fourth: If you are a minor, I must keep your parents or guardians informed of your progress, if they ask.  Details of conversations need not be revealed.


 

My foremost goal is client satisfaction.  Enclosed you will find a copy of my "Client Satisfaction Survey."  Sometime between now and our 3rd session, will you please fill it out and return it to me?  This is the best way I know to find out what I am doing right, and what skills I need to improve on.  You do not need to put your name on it, so you can feel free to be honest.  Thanks!


 

Feel free to ask me any questions regarding your treatment or progress, and let me know if there is a better way I can assist you.


 


 

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Client/Parent/Guardian Agreement                                                       Date