Client Informed Consent

Client/Therapist Agreement and Contract for Service

Please read through the entire document, and sign at the bottom.
Welcome! I am very excited to know you and am looking forward to our work together. The purpose of this agreement is to explain the policies of my practice and to inform you of the rules of confidentiality that I am bound to.   Your signature is required before I am able to speak with you for your first session. Please remit this form at your earliest convenience.
Paige Bartholomew

Fees & Payments:
• Weekly, Bi-weekly and Monthly Rates: Weekly appointments are billed at a lower rate than bi-weekly or monthly appointments to help clients afford therapy more often. (Click HERE for information about fees and sliding scales). It is recommended that weekly appointments be maintained for continuity, especially if you're engaged in trauma therapy or hypnotherapy. Meeting bi-weekly or monthly creates gaps in my work schedule that are nearly impossible to fill, hence a higher price. Creative scheduling at off-times may be necessary if you would like to meet less than once a week.
• Couples' sessions are 90 to 120 minutes long (depending on need), and are billed at a higher hourly rate than individual work.
• Overtime: Often, you may feel that you're work isn't finished at the 65 minute mark. If you need to go into overtime, a fee of $25 is charged for each 15 minute increment.
• Payments PayPal and Venmo are the preferred payment methods.
• Missed Sessions Must be "Made-Up":    Paige suffers from a chronic illness that causes occasional cancellations when flare-ups occur. Therefore, this office offers a creative rescheduling policy as follows: If either YOU or PAIGE cancel or miss a session for any reason (illness, lack of childcare, other emergency or non-emergency), multiple make-up session times will be offered for your convenience for the next 7 days, 10 am - 10 pm Central Time. If you are unable to make up your session within 7 days (or before your next appointment), you will be responsible for paying for the cancelled appointment . (Exceptions may be made in certain special circumstances determined by Paige Bartholomew). Every effort will be made by this office to help you attend a "make-up" session, so that your money isn't lost.
• Emergency sessions are available from 10 am to 10 pm, 7 days a week, as Paige is available.
• Your credit card will be kept on file, and is required to hold your appointments. A nominal charge will be made to your credit card upon commencement of work together, to make sure the card is valid and in working order. Your card will never be charged without speaking to you first. Credit card information is locked behind two locks, per Texas law. Your card will reserve the appointments you make, and will be used to cover fees which may be outstanding, such as missed-session fees.
• Paige is not on any insurance panels, but if you live in the state of Texas, you may request a superbill AT THE END OF EACH YEAR which you may use to file for out of network reimbursement.
• Fee increases: This office reserves the right to increase fees at any time, with 6 weeks' notice, given in writing via email. Fees typically increase yearly by $10-$15 per session.

Services Offered:
• 65 minute sessions (20 minutes longer than most therapists offer) • Overtime up to 30 minutes extra are available if needed • 24/7 Availability via text or email for check ins, to ask questions or visit as needed • Emergency sessions are available 7 days a week, 10 am - 10 pm, as Paige is available • Regular check-ins from Paige to you, via text/email
• Meeting Location: Sessions are held by PHONE, and occasionally by Facetime (at Paige's discretion).
•How long therapy will take?    Many issues can be addressed within short-term therapy (about 12 sessions), but more serious issues such as trauma, long-standing grief, relationship issues, childhood issues, abuse or addictions usually respond better to longer-term therapy. A good rule of thumb is that it takes one year of clinical work for every decade lived in a state of distress, pain, irresolution or dysfunction.   If you work with Paige, plan on longer-term therapy (6 - 24 months).
• You are in charge of your personal growth program. If you are struggling in therapy, it's your job to say something. If you don't like a certain exercise or practice - speak up. If you'd like to go in a different direction - tell Paige immediately. It is your job to advocate for your needs and wants. HELP YOUR THERAPIST HELP YOU.

Appointments & Cancellations:
• 24 BUSINESS HOURS' notice is required to cancel or reschedule an appointment
• We will agree to a weekly standing appointment. It is your responsibility to keep that appointment. If you miss it for any reason, you'll be given every opportunity to re-schedule the session before your next weekly session. If you don't take the opportunity to make up the session, you will still be responsible for the fee. This office will go above and beyond to serve you, offering make-up appointments 7 days a week from 10 am to 10 pm Central time, as Paige is available.
• The first 15 sessions will be scheduled weekly in order to build our relationship with rapport and trust. These first 15 consecutive weeks are vital to mastering the hypnosis work, and creating a trusting close connection..
• Modes of Communication: Email or text are my preferred modes of communication, and are the fastest way to get a hold of me. I do not check phone messages at all. My email address is Paige@PaigeBartholomew.com.
• Hours of Operation:: I live in Texas or the “Central" time zone. I generally work between the hours of 10 am and 10 pm, Central time. If you live overseas, please plan accordingly for phone or online communication sessions, as my caseload is usually very full, and very early or very late sessions (for your time) may be all that is available.

• Confidentiality: Therapists are bound by law to keep everything you say completely confidential. The exception to this is Couples work. When working with a couple - all cards will be kept on the table, at all times. All parties will agree that no secrets will be kept from the therapy work. Paige will not keep secrets from your partner. Paige is required by law not to share couples' information outside the couple sessions.

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Complaints: If you would like to make an official complaint to the Texas Board of Licensed Marriage and Family Therapists, please write to:
Complaints Management and Investigative Section
P.O. Box 141369
Austin, Texas 78714-1369

"I understand that this form is required BEFORE my first session. If the form isn’t submitted on time, the session will be rescheduled. My signature acknowledges that I have read, understood, and agree to the contents of this informed consent ."

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