Introduction
This document is intended to provide important information to you regarding your consultation/coaching session. Please read the entire document carefully and be sure to ask your consultant/coach/therapist any questions that you may have regarding its contents.

Fees
The fee for service is $95.00 per 50 minute individual consultation/coaching session.
The fee for service is $55.00 per 30 minute individual consultation/coaching session.
The fee for service for in person family consultation/coaching session will be determined on the travel destination.  Request a quote.  

Fees are payable before services are rendered.  No services are rendered without payment in advance.  Individual sessions are either approximately 50 minutes in length or 30 minutes in length depending on your appointment selection.

Group family interventions/consultation fees are based on time and travel to your location.  We are currently based in Ohio and Florida and we see families in those areas locally. We also travel to many cities in the United States to your home city or vacation site. We are happy to provide a fee quote.

Confidentiality
All communications between you and your consultant/coach will be held in strict confidence unless you provide written permission to release information about your treatment. If you participate in a family consultation/coaching or group meeting your consultant/coach will not disclose confidential information about your treatment unless all person(s) who participated in the treatment with you provide their written authorization to release. (In addition, your consultant/coach will not disclose information communicated privately to him or her by one family member, to any other family member without written permission.)
There are exceptions to confidentiality. For example, if your consultant is a therapist, counselor or life coach they are required to report instances of suspected child or elder abuse. Therapists, counselors and life coaches may be required or permitted to break confidentiality when they have determined that a patient presents a serious danger of physical violence to another person or when a patient is dangerous to him or herself.

Appointment Scheduling and Cancellation Policies
Sessions are scheduled at the client’s and consultant’s/coach’s discretion. Your consultant/coach may suggest a different type of treatment depending on the nature and severity of your concerns. In order to cancel or reschedule an individual telephone or individual appointment at our facility, you are expected to notify your consultant at least 24 hrs in advance of your appointment. If you do not provide your consultant with at least 24 hours notice in advance, you are responsible for payment for the missed session.
In order to cancel or reschedule a family consultation or intervention in your area, you are expected to notify your consultant at least 3 days in advance of your scheduled appointment. If you do not provide your consultant with at least 3 days notice in advance, you are responsible for payment of the session. No exceptions will be made.

Consultation Availability
Your consultant/coach will accept calls between sessions, but will attempt to keep those contacts brief due to our belief that important issues are better addressed within regularly scheduled sessions. You may leave a message for your consultant/coach at any time on his/her confidential voicemail. If you wish your consultant/coach to return your call, please be sure to leave your name and phone number(s), along with a brief message concerning the nature of your call. Non urgent phone calls are returned during normal workdays (Monday through Friday) usually within 24 hours between the hours of 9:00 AM – 5:00 PM. Center of Solutions, LLC is not a crisis center and is unable to help during acute crisis’s requiring immediate help.  In the event of an emotional or medical emergency or an emergency involving a threat to your safety or the safety of others, please call 911 to request emergency assistance.

Communications
Your consultant/coach may need to communicate with you by telephone, mail, or other means. Please indicate your preference by checking one of the choices listed below. Please be sure to inform your consultant/coach if you do not wish to be contacted at a particular time or place, or by a particular means.

My consultant/coach may call me at my home.

My home phone number is:

My cell phone number is:

My work phone number is:

My home address is:

My work address is:

My email address is:

About the Process
It is your consultant’s/coach’s intention to provide services that will assist you in reaching your goals. Based upon the information that you provide to your consultant/coach and the specifics of your situation, your consultant/coach will provide recommendations to you regarding your treatment. We believe that consultants/coaches and clients are partners in this process. You have the right to agree or disagree with your consultant’s/coach’s recommendations. Your consultant/coach will also periodically provide feedback to you regarding your progress and will invite your participation in the discussion. Due to the varying nature and severity of problems and the individuality of each client, your consultant/coach is unable to predict the length of your sessions or to guarantee a specific outcome or result. It is also important to realize that working with family issues has potential emotional risks. Approaching feelings or thoughts that you have tried not to think about for a long time may be painful.  Sessions, interventions, family meetings and consultations may also involve the risk of remembering unpleasant events that could arouse strong feelings.  Therapy, counseling, crisis intervention, consultation, and education services may have a profound impact. Our work is very intensive and can be stressful.
We do not treat mental disorders as defined specifically in the DSM-IV. If you have anything in your past indicating that you have unresolved and serious emotional or physical problem or a mental disorder, by signing this form you agree that you are not using a consultation or coaching session as a substitute for assistance from a mental health professional or medical doctor.  You are also agreeing that you will not use coaching or consultations as a substitute for counseling, psychotherapy, psychoanalysis, mental health care or substance abuse treatment.

Be advised that a family consultation with Family-Intervention.net is not therapy. A family intervention or family meeting is a consultation and should not be considered a therapeutic process.

Family Sessions and Family Consultations

An intensive family intervention is a meeting between members of the family group and one or two consultants who facilitate the conversations. The overall goal of the consultation is to review the dynamics of family life and relationships in the past and present and to renegotiate those relationships in support of greater health and well being.  In your family meeting, family members come together in a live encounter and address issues that matter in the past, present and future. With the care and guidance of the consultants, family members discuss a variety of issues so that each family member’s thoughts and feelings may be spoken and heard.

Most families have no immediate crisis, but do have a desire to come together to address issues: past history, relationships, feelings that have evolved over the years.  Some families have experienced a death, loss, significant change or some other challenge that are in need of support and collaboration with family to move forward.  Other families have experienced particular distresses over the years with lingering and unresolved feelings of anger, hurt, and resentment. In these situations, the intention is to come together in conversations with the assistance of consultants so that family members and the family as a group may learn, grow, and move forward with courage, hope and newly discovered possibilities.

There are several processes to the consultation:

1. A family member will contact us for information which may lead to an agreement to proceed with the family intervention or meeting.  A contract is agreed upon and the dates for the consultation are set.
2. All family members are sent a letter from the consultants/coaches outlining the goals, format, and schedule of consultation.
3. Each family member is contacted by phone by one of the consultants/coaches prior to the family consultation.
4. The family meeting/consultation takes place over several hours or longer if needed.
5. A brief follow up letter will follow to each family member involved in the family meeting/intervention.

Termination
The length of your consultation and the timing of the eventual termination of your treatment depend on the specifics of your treatment plan and the progress you achieve. It is a good idea to plan for your termination, in collaboration with your consultant/coach. Your consultant/coach will discuss a plan for termination with you as you approach the completion of your goals.
You may discontinue working with us at any time. If you or your consultant/coach determines that you are not benefiting from treatment, either of you may elect to initiate a discussion of your alternatives. Alternatives may include, among other possibilities, referral, or terminating your sessions.

Your acceptanceindicates that you have read this agreement for services carefully and understand its contents.

Please ask your consultant to address any questions or concerns that you have about this information before you accept.

This is an esignature form. By typing your name in the box it is the same as signing your signature and is legally binding.

Type your full name:

I have read and agree to the terms of this disclosure:

Yes, I agree with the terms and conditions of the disclosure statement and agreement for services.

No, I do not agree with the terms and conditions of the disclosure statement and agreement for services.