Elizabeth Hess Stamper, LMHC
2085 Hwy A1A, Unit 3601, Indian Harbour Beach, FL 32937
703-887-6571 EHStamper@gmail.com
CLIENT AGREEMENT
I affirm that I am entering into this therapy relationship freely and will participate as fully as I can including completion of any assignments between sessions.
I understand that my development as a person may require me to move beyond what’s comfortable and familiar and that I am the one who ultimately decides how much to stretch.
Confidentiality regarding my work with Elizabeth will be honored and maintained.
If I find myself disengaging from the healing process, I will do my best to let Elizabeth know when it happens so we can discuss what might help me re-engage fully.
I agree to be as open and candid as possible to gain the most from therapy.
Cancellation policy: Please communicate all cancellations and scheduling requests via this email: ehstamper@gmail.com.
If cancelled less than 24 hours before appointment time, then fee is $45. Fee may be forgiven if due to unforeseen circumstances or if therapist is able to rebook the time.
How to Pay:
Cash or check to: Elizabeth Stamper
Zelle: NEW VISION COUNSELING CENTER, ehstamper@gmail.com)
Venmo: Elizabeth-Stamper-7 703-887-6571
PayPal:* NEW VISION COUNSELING CENTER, paypal.me/EStamper497
*Please add $3 for PayPal’s fee.
By submitting this form I agree that I have filled out this information truthfully, and to the best of my ability.
By submitting this form I agree that I have filled out this information truthfully, and to the best of my ability.