The Top 10 Treatment Essentials Agreement
  Please complete and submit this Agreement in order to successfully meet the requirements of continuing in this Treatment Program.
  Also, be sure to click on the "SUBMIT" Button at the bottom of this Worksheet after you have completed all items, and before you exit this page so that your Response will be logged.
  Once you have completed this Agreement and submitted it, please be sure to clear this from your browser.
  Please respond to the following items Truthfully and Thoughtfully.

Developed by Dr. Beverly (November 2022)
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Email *
Please type your first and last names.  After this, type in the year you were born. *
Please list Today's Date (Feche), the Current Time, and if you are on Probation of Diversion, please list the City where your Probation or Diversion Office is.  Otherwise, please list which City you live in. *
1. TREATMENT SETTINGS: Please NOTE: (All of Dr. B's DV Treatment Sessions are In-Person at this point in time except for those persons who due to serious Disability or other debilitating circumstances that make it literally impossible for this person to attend In-Person.  In order to conduct any sessions remotely (as of October 1, 2022) both Dr. B and the Client must have special equipment and software.  If any remote sessions are scheduled, this must be by Special Arrangement with Dr. B and they will be billed at the higher Individual Session Rate.)  
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2. JUMPING GROUPS: If you are planning to start attending a Group that you have never attended, or if you are planning to attend a Group that you normally do not attend, please try to let Dr. B know about this at least 24 hours in advance of that Group Session.  And please do so via Text message.  

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3. IN-PERSON GROUP DISCLOSURE: It is important that if attending an In-person Group that you complete this In-Person Group Session Attendance Disclosure & Consent Form prior to attending (Please also see Item #5 below).

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4. GROUP LOCATIONS: If you plan to attend one of these Groups and you do not know where they are, please TEXT Dr. B. and he will send you the address.
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5. COMPLETING WORKSHEETS: Please note that regardless of how a person attends any DV Session, she/he is responsible for completing the Worksheet(s) for that DV Session online on that day.  The link for Worksheets is typically at or near the bottom of the Blog Entry for that week.  So every time you attend a Group, you will be expected to complete the weekly DV Topic Worksheet (typically done online) that will be Linked to the Weekly Topic on the Blog which can be found at this Link here: Dr Bs DV Prevention & Education Blog or  at https://drbsdvpreventionandeducation.blogspot.com/   It is your responsibility to get these done every week.  If you have a challenge that makes it impossible for you to complete your work this way; or if you need help learning how to do this, it is your responsibility to get help from someone you know with this task, or to TEXT Dr. B and get help with this task.  It is important that you understand that if these worksheets are not completed, you cannot complete your DV Treatment. 

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6. SESSION FEEDBACK FORMS: Each Time you Attend a DV Treatment Session, you will also be required to complete a Session Feedback Form (typically done online) that can be found on the Blog anywhere you find an American Flag on this Blog, or AT THIS LINK RIGHT HERE.  Or just go the Link listed below: https://drbsdvpreventionandeducation.blogspot.com/2020/04/thank-you-for-visiting-dr-bs-dv.html  Sometimes -- but rarely --  Worksheets and Feedback forms can be completed on paper if provided by Dr. Beverly.  Either way, it is your responsibility to see that your weekly Worksheets and Feedback Forms are completed before you finish your DV Treatment. It is your responsibility to get these done every week.  If these are not completed, you cannot complete your DV Treatment.
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7. PAYING FOR YOUR TREATMENT SESSIONS: Please also note that regardless of how a person attends any DV Session, she/he is also responsible for paying the fee for the Group Session online or in-person at the time of the Session.  Every client is required to pay for their DV Treatment Services every week as they attend.  Please CLICK THIS LINK RIGHT HERE to learn about how to pay for your DV Treatment, or just go to this Link listed here. https://drbsdvpreventionandeducation.blogspot.com/2022/01/very-important-notice-about-paying-for.html   If these payments are not made in full, you cannot complete your DV Treatment.

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8. ABSENCES: Also, if you miss a week of DV Treatment, you are required to complete an Absence Attestation form which is AT THIS LINK RIGHT HERE, or may also be located by using this Link listed here: https://drbsdvpreventionandeducation.blogspot.com/2020/05/absence-attestation-complete-your.html  If these attestations are not completed, you cannot complete your DV Treatment.  Also Please Note: Once you start attending one of these Groups, it is best if you stick with the same Group throughout your Treatment.  It is also best to NOT miss more than 2 Sessions throughout the course of your treatment.  Anyone with 3 or more absences may be subject to involuntary discharge.
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9. YOUR RESPONSIBILITY: You should know about, understand and do every task as described above every week.  This is your responsibility.  If you get behind, it is your responsibility to keep up with where you are.  And it is your responsibility to catch up right away.

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10. ALWAYS BE RESPECTFUL: Please keep in mind that this DV Treatment is being provided by skilled professionals with the intent of helping you improve your life, improve your relationships, and complete your  your Court, Probation, Diversion or Parole requirements.  Please always be respectful to Staff, Fellow Clients, and the Facility.  And please remember that confidentiality about who you see here and what they say here while in Group Sessions is an essential part of showing Respect.  Thank you.
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Please mark "Yes" below that you understand and agree to all of the Conditions above and that you understand that the above conditions are intended to compliment all previously agreed to conditions related to your DV Treatment. *
Thank you for completing this Agreement.  Hit "SUBMIT" below.
Be sure to click on the "SUBMIT" Button so that your work will be sent to Dr. Beverly.  After submitting this form, click on the X at the top right corner of your screen.  Have a nice day?    (c. 2022, Dr. Beverly)

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