I. INFORMED CONSENT AGREEMENT, TERMS & CONDITIONS IN REGARDS TO SESSIONS.
Therapy involves both benefits and risks. Risks include the possibility of experiencing uncomfortable levels of feelings like sadness, guilt, anxiety, anger, loneliness and helplessness. Therapy often requires recalling experiences, some of which may be unpleasant. Therapy may involve making changes that can feel uncomfortable to you and those close to you. Should you notice any negative effects, please tell us immediately.
We will make every effort to remedy the situation or provide you with names of other therapists should you prefer a referral. Working with trauma healing and energy medicine has been shown to have benefits for those who undertake it. It often leads to reduction of feelings of distress, and to better relationships and resolution of specific problems. The objective is to find more peace, joy, and healthier relationships.
Please read the following statements carefully. If you agree to all terms, you may continue booking a session with Kalisa Augustine. Sessions occur weekly, or bi-monthly until all healing and growth goals are complete. Kalisa Augustine’s services are ongoing therapeutic processes. It is required that you understand and consent to the following terms regarding your healing sessions and experiences. I look forward to working with you. Thank you.
1. I agree to have a credit card saved on file to be used for regular sessions and fees incurred. I understand that my card is charged on the day of my session as a convenience unless otherwise specified by the client, discussed and agreed upon by both parties. I understand Kalisa also accepts Venmo, however a credit card must be on file as a secondary payment option. If Venmo is being used, my payment must be made prior to the session, otherwise my credit card will be charged.
2. I understand that there is a minimum commitment of 10 sessions, after booking my initial client intake, required in order to work with Kalisa Augustine. I understand that my participation and commitment is a necessary component of my personal growth. I understand that 10 sessions is only the beginning of a new journey, and I can continue therapy with Kalisa if I see fit thereafter.
3. I understand that somatic, neurophysiological, spiritually transformative and energy healing processes may affect my physical, emotional, mental and spiritual states of being while I integrate the benefits of my healing work. I understand that integration may feel intense, uncomfortable or foreign. I understand this and am willing to show up for myself, anyways.
4. I understand the possible temporary side affects from my treatment could manifest as: fatigue, sense of loss, exhaustion, minor pain, physical detox, emotional detox, brain fog, anguish, revelation, increased sensory intelligence, heightened sensitivity, and potentially a desire to change my life externally.
5. I understand that a minimum of 48 hours is required for the brain to reach a state of coherence.
6. I understand that the effects of healing treatments with Kalisa Augustine vary from person to person depending on individualistic client conditions.
7. I understand no guarantee can be made concerning the results of the treatment.
8. I understand that working with Kalisa Augustine is not a replacement for standard medical practice.
9. Should any medical or psychiatric problems arise, I assume full responsibility to consult with the appropriate physicians. I understand that Kalisa Augustine is not a medical doctor in the United States.
10. I am aware that treatment may include but is not limited to brainspotting, counsel, vibrational medicine, energy healing, spiritual teaching on consciousness expansion.
11. I understand that appointments are scheduled weekly or bi-monthly and on a regular basis until I have accomplished the majority of my goals and other arrangements are made. I understand that committed participation is required to support the integrity of my growth.
12. I understand that the purpose of my initial client intake session is to educate myself on the process, share all relevant information about my personal life issues, experience Kalisa’s work, and assess if this is the right support path for me moving forward.
As part of the counseling process, I am bound by moral accountability to keep confidential the information shared during the sessions and will not release any information without your written permission. There are important exceptions to the confidentiality of the counseling relationship.
I may reveal certain information under the following circumstances:
a) Disclosure of serious intent to do harm to self or others.
b) Disclosure of child abuse or my suspicion of child abuse, elder abuse, or dependent adult abuse.
• Expansion Sessions - 300 / 90 min
• Teen Sessions 222 / 60 min
• Initial Client Intake: 400 / 120 min
Please contact firstname.lastname@example.org to request optional BIPOC pricing.
CANCELLATIONS AND MISSED APPOINTMENTS:
Cancellation of appointments must be made at least 24 hours in advance. A credit card number will be taken at the onset of your counseling. Late cancellations will be charged at the regular hourly fee to your credit card.
Payment is expected at each session unless other arrangements have been made in advance. You are responsible for payment for all services rendered either by debit card, credit card, or Venmo.
TELEPHONE, TEXT AND EMAIL POLICY:
Generally, I ask that clients reserve discussing problems that arise between sessions for the next scheduled appointment time. We encourage you to use resources you have and to reach out to your support system. Unless there is an emergency, our schedules do not permit us to talk on the phone, respond to lengthy texts or answer lengthy emails in between sessions. If you feel the need to text or email information beyond the routine scheduling of appointments, or corresponding follow ups, we will wait to discuss the content in our next scheduled session. If telephone calls are necessary for a client emergency, please schedule a time for a telephone consultation, which will be charged at our regular rates (In 15-minute segments). Please do not text anything other than appointment times as confidentiality is not secure with texting.
I hereby request and consent for Kalisa Augustine to perform treatment according to professional standards as outlined on the website www.kalisaaugustine.com and as stated in this agreement.
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