If you are a PROSPECTIVE CLIENT who has not had a PRELIMINARY PHONE CONSULTATION with us, please click here. DO NOT submit this Agreement.
NEW CLIENTS who have had a PRELIMINARY PHONE CONSULTATION with us must read through all terms of this Agreement, fill it out accordingly, and submit.
TERMS OF AGREEMENT
Benefits and Risks – Sessions may involve discussing unpleasant aspects of your life and, as a result, you may sometimes experience uncomfortable feelings. Our goal is to provide a safe and healthy environment. Sessions have been shown to have many benefits - better relationships, solutions to problems, and significant reductions in feelings of distress. There is no guarantee that you will experience any or all of these benefits.
Confidentiality – ALL INFORMATION YOU SHARE WITH US IS CONFIDENTIAL.
Exceptions to Confidentiality – Exceptions include, but are not limited to: reporting child, elder, and dependent adult abuse, serious threat of violence towards a reasonably identifiable victim, and danger to self or to the person or property of another.
Insurance – We do not accept insurance of any kind. We do not provide any big bills or receipts for Insurance.
Fees & Payments – Prices are provided on the Your Sessions page. Payments for all sessions must be made in full either before or immediately following your session by Cash or Venmo. We will not invoice you. Your fee will adjust yearly. We do not provide a sliding scale.
To book your First Session, you must provide your credit card information in the form below. We will place a $50 Authorization on it to hold your spot in good faith. You will be charged this $50 if you fail to show up, reschedule or cancel within 24 hours. (This is for First Time Clients Only) All others must follow the Cancellation Policy below.
Cancellation / Late Policy – You must cancel your appointment 24 HOURS IN ADVANCE of your scheduled appointment. NO EXCEPTIONS. If you call the morning of of your session, you will need to pay the FULL session fee. By submitting this Agreement, you acknowledge that you will be charged an ENTIRE SESSION FEE on the credit card provided. You also agree to forfeit your appointment if you are more than 15 minutes late. At this time, you agree to pay the full amount for the session. We do not extend appointments beyond your original out time.
Los Angeles Office Premises – Please be advised, this office does have stairs and does not have an elevator. RELEASE: In consideration of services of property provided, I do hereby release any and all parties associated with Evolve Therapy, Coaching, Hypnotherapy, Therapy-Coaching Room, Los Angeles Hypnotherapy, its principal directors, and each and every landowner, upon whose property activity is conducted, from all liability and waive any claim for damage arising from any cause whatsoever.
Online Worldwide Sessions – We will initiate the call at your scheduled time via FaceTime, Skype or Zoom.
1. We must know in advance that your session will be online. Please make note of that in the "notes" when you are scheduling your appointment.
2. Your set-up is critical. Please make sure your desktop or laptop are hard-wired to your modem with an Ethernet cable. Do not rely on WiFi.
3. Our office is guaranteed hard-wired with little to no drop-outs. In the event of drop-outs from your end, we will try and initiate the call again up to 3x, before the session will be deemed a forfeit and paid in full. So, the better wired you are, the more of a guarantee of no interruptions. We will not extend the session to make up for bad connection.
4. Please make sure you are alone in a quiet room without any interruptions. (Do not do this when members of your household are present).
Legal Cases – We will not enter any legal situation you are currently in or become involved with, including marital divorces, DCFS cases, etc. No exceptions.
Forms – We do not sign any forms for Therapy Dogs, Worker's Compensation, Medical Leave, or any other services.
Termination of Sessions – You, as the Client, or we as the Counselors/Hypnotherapists/Coaches/Practitioners can stop sessions at any time. Sessions may be terminated due to, but not limited to the following: excessive no shows or cancellations, lack of payment, or if we deem that adequate progress is not being made.
Contact In Between Sessions – You may TEXT anytime during working hours 9am to 7pm PST. Please be advised that we will respond as soon as possible. If you need to speak with us on the phone, we will spend 10 minutes only on the phone before charging you for a single session.
Couples – Must call, text and come together (no exceptions).
COVID-19 Health & Safety Protocol – We will not see people in-person who have not been fully vaccinated. We can conduct your session online, provided you comply with our Online Worldwide Session instructions as noted above. If you have very little exposure (no parties, weddings, large groups), we may consider seeing you on our outside patio (Individual Therapy/Coaching for Individuals and Couples only, no Hypnotherapy).
Diagnosis – This practice is not required to accept any clients who have been diagnosed with serious Mental Diagnosis and/or Personality Disorders.
Thank you. Your acknowledgement of the Agreement and all other required information has been successfully sent.