Informed Consent for Psychotherapy

Nature and Purpose of Psychotherapy

Psychotherapy is a collaborative process designed to support emotional growth and mental health. It involves working with a therapist to explore thoughts, feelings, and behaviors to promote positive change. Results are not guaranteed, and progress depends on a variety of factors including your active participation.

Potential Risks and Benefits

Benefits of therapy may include improved insight, better coping skills, enhanced relationships, and greater emotional resilience. Risks may include temporary emotional discomfort or distress as difficult topics are explored during the therapeutic process. Your therapist will work with you to manage any discomfort that arises.

Voluntary Participation

Your participation in therapy is entirely voluntary. You have the right to discontinue services at any time without penalty. If you choose to end therapy, we encourage you to discuss this with your therapist so that an appropriate transition plan can be established.

Confidentiality

All information shared in therapy is strictly confidential. Exceptions to confidentiality exist as required by law, including: (1) suspected abuse or neglect of a child or vulnerable adult; (2) credible threat of danger to yourself or others; (3) court orders requiring disclosure. Your therapist will always discuss these limits with you.

Telehealth Services

Services are primarily provided via secure, HIPAA-compliant telehealth platforms. By signing this form, you consent to receiving telehealth services when applicable. You agree to participate in sessions from a private space and to take reasonable steps to protect your own confidentiality during virtual sessions.

Fees and Payment Policy

One Life Wellness uses a sliding fee scale ranging from $50–$150 per session. You select the fee that best fits your financial situation. Payment is due at the time of service. Fees may be revisited and adjusted as financial circumstances change — please speak with your therapist if adjustments are needed.

Insurance

One Life Wellness is an out-of-network provider and does not bill insurance directly. Upon request, we will provide a superbill that you may submit to your insurance company for potential reimbursement, subject to your individual plan benefits.

Cancellations

We require at least 24 hours' notice for session cancellations or rescheduling. Cancellations made with less than 24 hours' notice may result in the full session fee being charged. Consistent attendance supports your therapeutic progress.

Emergency Situations

This practice does not provide crisis or emergency services. If you are experiencing a mental health emergency, please call 911 immediately or contact the Suicide & Crisis Lifeline by calling or texting 988. Please inform your therapist if you are in crisis so that appropriate referrals can be made.

Client Responsibilities

As a client, you agree to: attend scheduled sessions consistently; participate honestly and openly in the therapeutic process; communicate any concerns about your treatment directly with your therapist; and when using telehealth, participate from a private and distraction-free space with a reliable internet connection.

Therapist Responsibilities

Your therapist agrees to: provide ethical, professional, and compassionate services; maintain strict confidentiality within legal limits; collaborate with you to set and work toward therapeutic goals; and provide appropriate referrals when your needs fall outside the scope of this practice.

Records and Documentation

Minimal records are maintained as required by professional and legal standards. Your records are kept confidential and secure. You have the right to request access to your records in accordance with applicable law.