Ongoing Counseling Services Agreement

This agreement sets out the terms of ongoing psychological counseling between the practice or licensed therapist ("Provider") and the person receiving services ("Client"). It becomes effective only when BOTH parties have signed below. The Provider completes the fee schedule and policies before sharing, then the Client reviews and countersigns — either in-app, or by printing, signing, and uploading a scanned copy.

Section 1 — Parties

Provider (practice / therapist name):

License number and jurisdiction:

Client (full legal name):

Client email:

Client phone:

Start date of services:

Section 2 — Services & Approach

The Provider will offer counseling services using professional judgment and evidence-informed methods. Therapy is a collaborative process; outcomes cannot be guaranteed, and the Client may end services at any time. The Provider outlines the intended approach and typical session length below.

Primary approach / modality:

Typical session length:

Expected frequency of sessions:

I understand the nature and approach of the counseling services described above.

Section 3 — Fees & Payment

The fees below are set by the Provider. Payment is due at the time of each session unless otherwise agreed in writing.

Accepted payment methods:

I have read and agree to the fees and payment terms set out above.

Section 4 — Cancellation Policy

Sessions are reserved specifically for the Client. The notice period required to cancel or reschedule without charge is stated below.

Required cancellation notice:

I understand that cancellations with less than the stated notice may be charged the applicable fee.

Section 5 — Confidentiality & Its Limits

What is shared in sessions is confidential and protected by professional and legal standards, with limited exceptions: risk of serious harm to self or others, suspected abuse of a child or vulnerable adult, and disclosures required by a court order or by law.

I understand that confidentiality applies except where disclosure is required to prevent serious harm or by law.

I understand how my records are stored and who may access them.

Section 6 — Communication & Emergencies

Between-session messages are for scheduling and brief matters and are not monitored continuously. Counseling is not an emergency service. If you are in crisis or at risk, contact local emergency services or a crisis line immediately.

Preferred contact method between sessions:

Email

Phone

Secure client portal

I understand that counseling is not a crisis service and know how to reach emergency support if needed.

Section 7 — Acknowledgments

I have read and understood each section of this agreement.

I have had the opportunity to ask questions and seek independent advice.

I understand that I may end counseling at any time.

I consent to electronic signatures having the same legal effect as handwritten signatures.

I consent to receive counseling-related communications and copies by email.

Section 8 — Signatures

Provider — Practice / Therapist

Printed name:

Date:

Client

Printed name:

Date:

Optional — upload a countersigned scan or supporting document:

This template is provided for reference only and does not constitute legal or clinical advice. Consult qualified counsel and follow the licensing and privacy rules in your jurisdiction before relying on this document.