PEACE HUB COUNSELING
 Counseling  Appointment                                                            www.peacehubinternational.com
 
Informed Consent and Authorization for Services
I hereby make application to receive services from Peace Hub Counseling and Well- Being Centre and i have been informed about fee and limits of Confidentiality. I understand that all information obtained will be maintained in a confidential manner. I further understand that no information shall be released or obtained without my written consent except in the condition of ' duty to warn ' as detailed in the limites of confidentiality .My fee Rs.800 (India )
for 1 hour has been explained and found acceptable.




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Counseling Appoinment Fee Rs.800 (India) .

Pls Note : Counseling Fee Rs.800 (India),  for 1 hour. Fees are charged only for the time taken for counseling. The appointment fee will be deducted from the amount of total time taken for counselling. Subsequent fees are payable after the session


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Peace Hub , A Centre for Human Well-being

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