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Therapeutic Services Agreement & Informed Consent

Sarah Mitchell · Aug 2025 - Aug 2026

Dr. Amara Williams

Signed

Therapeutic Services Agreement & Informed Consent

Service Provider

Dr. Amara Williams

Clinical Psychologist & Therapist

info@williamspsy.com

Client

Sarah Mitchell

sarah.mitchell@email.com

Effective: August 14th, 2025
Expires: August 14th, 2026

1. Services

Dr. Amara Williams agrees to provide individual psychotherapy services utilizing Cognitive Behavioral Therapy (CBT) and integrative approaches for the treatment of Generalized Anxiety Disorder. Sessions will be held weekly, each lasting 50 minutes, with a review at session 8.

2. Duration

This agreement shall be effective from August 14, 2025 to August 14, 2026, for an initial period of 16 sessions with the option to continue on a session-by-session basis thereafter.

3. Compensation

The Client agrees to pay $180 per 50-minute individual session. 8-session packages are available at $1,280. Payment is due at the time of service unless an alternative arrangement is agreed in writing.

4. Confidentiality

All information shared in sessions is confidential, subject to mandatory reporting exceptions including imminent danger to self or others, child abuse, and court orders. Between-session contact is limited to scheduling and brief administrative matters.

5. Cancellation Policy

Cancellations must be made at least 24 hours in advance to avoid the full session fee. Dr. Williams is a licensed Clinical Psychologist. Therapy is not a substitute for psychiatric medication management or emergency mental health services.

Service Provider

Dr. Amara Williams

Signature

Client

Sarah Mitchell

Signature

Signed on August 12th, 2025