Thank you for your time filling out the form, please read the information on fee, confidentiality and agreements below, sign your name and submit. I look forward to meeting you.
Session fee is USD 195 per 50 minute session; Fees are due be paid to Paypal account firstname.lastname@example.org within 24 hours after the session.
Appointment Cancellation Policy: In the event that you must cancel or reschedule a session, please inform Cecilia as soon as possible through email. You are asked to pay the full fee for each missed session without twenty-four hour notice provided.
Professional Ethics: I, Cecilia Ding, subscribe to the Code of Ethics and Standards of Practice of the American Counseling Association (http://aca.convio.net)，ICF Code of Ethics, Canadian Counselling and Psychotherapy Association.
Confidentiality and Release of Information: In recognition that confidentiality is an integral part of successful relationship, I maintain confidentiality with respect to every aspect of the treatment process, including a client’s name. In no situation, except as is necessary for case consultation with another professional or as required by law, will I reveal any aspect of your personal information. In all other circumstances, release of information requires your express written consent.
Waiver of Liability. From time to time, I attend provide peer guidance and case consultation with my peer group, and general details of cases are shared in this confidential supervision process.
By signing this waiver of responsibility, you release Cecilia Ding from any real or perceived liability arising out of the services provided.
By signing my name and the date below, I agree that I have read the information above and agree to abide by these policies. In the case of any disagreement, conflict or misunderstanding, I agree to work within a mutually agreed mediation process. I will not under any circumstances pursue litigation against Cecilia Ding.