STATEMENT OF UNDERSTANDING
My time is made available for Professional Counselling and Psychotherapy on a fee for service basis. I charge $110 per 50 minute session. I am open to discussing a lower fee if your financial situation would preclude you from getting the support you need. I only ask that if your circumstances improve you inform me and begin/return to paying my regular fee. Payment is due upon the completion of each session and a receipt will be provided. In the case of third party payments, arrangements will be made to insure the process is as smooth and simple as possible.
My fee covers in-office time. There is no cost for brief phone consultations. Services such as report or letter writing will be billed at my hourly rate. Any additional charge will be made known in advance or at the time the service is rendered.
I do not provide emergency services, so in case of emergency contact the emergency department of the nearest hospital or one of the crisis 
lines listed in front pages of your local phone directory or on my web page at gsummerhayes.com. However, I do pick up my messages regularly and as soon as I am able I will respond to any urgent calls. But, as my schedule is unpredictable it is important not to depend upon an immediate response.
My cancellation policy requires you to notify me 24 hours (1 business day) in advance of your scheduled appointment if you will be unable to attend, except in the case of an emergency which precludes the possibility of providing advanced warning. If proper notification is not received you are responsible for paying the cost of the appointment (i.e. $110)
Everything that is discussed in the process of our work together and the record thereof is confidential and
cannot be released to a third party without your informed consent. Generally this must be done in writing, but in urgent situations a verbal consent may be given followed, as soon as possible thereafter, by a written consent. The exceptions to this policy are if there is an imminent threat to you or someone else’s physical safety, if there is any indications of possible child abuse or information is required by a court of law through subpoena or warrant.
The services I offer are made available to you on a strictly voluntary basis. This means your involvement is wholly within your discretion. Agreements with a third party to attend counselling are fine, but it is the responsibility of that third party to monitor your attendance if such scrutiny is required. I will not be responsible for supervising attendance nor will I report back to a third party on your progress unless so stipulated by you through a signed consent form.
To the best of my ability I will provide you with fair counsel that is respectful of race, religion, gender and sexual orientation. In 
circumstances where my ability to be objective is in doubt or my expertise is limited it will be my responsibility to assist you in getting the help you require. Any referral will be at no cost to you, but you will be responsible for compensating a new Counsellor for any service rendered.
Your signature indicates you have read and understand this statement.
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Signature of Client Date