Consent for Counseling

COUNSELING SERVICES

Counseling is a relationship between people that works in part because of clearly defined

rights and responsibilities held by each person. Counseling has both benefits and risks.

Risks may include experiencing uncomfortable feelings, such as sadness, guilt, anxiety,

anger, frustration, loneliness and helplessness, because the process of counseling often

requires discussing the unpleasant aspects of your life. However, counseling has been

shown to have benefits for individuals who undertake it. Counseling often leads to a

significant reduction in feelings of distress, increased satisfaction in interpersonal

relationships, greater personal awareness and insight, increased skills for managing stress

and resolutions to specific problems. But, there are no guarantees about what will happen.

Counseling requires a very active effort on your part. In order to be most successful, you

will have to work on things we discuss outside of sessions.

The first sessions will involve an evaluation of your needs. This will allow us to evaluate

needs, and areas of difficulty in order to establish the best counseling goals for you as an

individual. You should evaluate this information and make your own assessment about

whether you feel comfortable working with me. If you have questions about my procedures,

we should discuss them whenever they arise. If your doubts persist, I will be happy to help

you set up a meeting with another mental health professional.

APPOINTMENTS

Appointments will ordinarily be of a fixed duration, on a frequency which we agree upon. If

you need to cancel or reschedule a session, I ask that you provide me with 24 hours notice.

If you miss a session without canceling, or cancel with less than 24 hour notice, my policy is

to collect the full amount of your total session cost [unless we both agree that you

were unable to attend due to circumstances beyond your control]. It is important to note

that insurance companies do not provide reimbursement for canceled sessions; thus, you

will be responsible for the portion of the fee as described above. If it is possible, I will try to

find another time to reschedule the appointment. In addition, you are responsible for

calling in to your session on time; if you are late, your appointment will still need to end on

time.

PAYMENT

Payment may be made by electronic transfer and is the client responsibility to pay upon

completion of the service appointment. I am not able to process credit card charges as

payment. If you refuse to pay your debt, I reserve the right to use an attorney or collection

agency to secure payment.

Vosburg Counseling does not provide billing directly to insurance providers. Therefore, it is

the sole responsibility of the client to pay for the cost of services directly. It may be

possible to obtain reimbursement from your insurance provider, for which you will be given

an invoice and receipt of payment for services. It is the responsibility of the client to

contact their insurance provider to determine their eligibility for reimbursement, if any,

prior to sessions.

You agree to pay fees after each session by using the banking transfer information location

on the invoice. An invoice will be provided at the close of each session

stating the date of the session which took place and the amount owed. It is requested that

the client pay the invoice within 5 business days, unless otherwise agreed upon.

CONTACTING ME
I am most often unavailable by telephone as I may be with a client. Please use email as the

primary form of communication (vosburgscounseling@gmail.com). I do my best to respond

to emails within 24-48 hours, excluding weekends. If there is any urgent matter, please 1)

call 112 (in the Netherlands) and ask to speak to the mental health worker on call; 2) go to

your local hospital Emergency Room, or 3) Call Crisismeldpunt at 0883580999. I will make

every attempt to inform you in advance of planned absences.

OTHER

If you are unhappy with what is happening in counseling, I hope you will talk with me so

that I can respond to your concerns. Such comments will be taken seriously and handled

with care and respect. You may also request that I assist in finding you alternative

counseling and are free to end services at any time. You have the right to considerate, safe

and respectful care, without discrimination as to race, ethnicity, color, gender, sexual

orientation, sexual identity, age, religion, national origin, or ability. You have the right to

ask questions about any aspects of counseling and about my specific training and

experience. You have the right to expect that I will not have social or sexual relationships

with clients or with former clients