Disclaimer
The information provided herein is intended solely for illustrative purposes related to agreements for therapeutic services. It does not constitute legal or professional advice and should not be relied upon as a substitute for consulting a qualified legal or mental health professional. Legal requirements and guidelines may vary depending on the jurisdiction, and adjustments may be necessary to ensure compliance with local laws. The use of this template is at the user’s own risk, and no liability is assumed for any errors, omissions, or consequences resulting from its use without proper review by a qualified professional.
Please note: This is a sample Therapy Contract template for illustrative purposes only. Actual terms may differ based on specific agreements and applicable laws.
Therapy Contract Sample
Parties Involved:
Therapist: Jane Doe, Licensed Mental Health Counselor
Address: 123 Wellness Blvd, New York, NY 10001
Client: John Smith
Address: 456 Elm Street, New York, NY 10002
Service Description:
The therapist shall provide mental health counseling services to the client as outlined in this agreement, including individual sessions, assessments, and treatment planning.
Payment Terms:
The client agrees to pay a fee of $150 per session. Payment is due at the time of each session unless otherwise agreed. Insurance billing details are provided separately.
Therapist Responsibilities:
The therapist agrees to provide professional mental health services consistent with applicable standards and to maintain confidentiality as per legal and ethical guidelines.
Governing Law:
This agreement shall be governed by the laws of the State of New York. Disputes shall be resolved within the jurisdiction of the New York courts.
Additional Provisions:
- The client agrees to attend scheduled sessions punctually and communicate any cancellations in advance.
- This agreement may be modified only through written consent signed by both parties.
- Confidentiality will be maintained unless disclosure is required by law or necessary to prevent harm.
New York, ______________________
Jane Doe, LMHC
John Smith