From: vedwards@emr.ca (Victoria Edwards)
Date: Thu, 15 Sep 1994 07:51:36 -0400 (EDT)

> 
> >   Tear Out Shopping List
> >                   Questions to ask a possible therapist
> >                             _________
> >                             Attitudes
> > *Have you worked with lesbian/gay clients?
> > *What has your experience been?
> > *How do you feel about a lesbian or gay orientation?
> > *Have your attitudes changed?
> > *How?
> > *From your point of view, what causes sexual orientation?
> >                          ----------------------
> >                           Training & Experience
> > 
> > *What is your training and experience? License?
> > *What is your approach or theoretical orientation?
> > 
> >                               ________
> >                                Money
> > 
> > *What is your fee? 
> > *Do you have a sliding fee scale?
> > *If so, what is your scale?
> > *Do you charge for the first session?
> > *Can I count on this fee as long as I am in therapy with you?
> > *If not, what can I expect?
> > *When?
> > *I want to pay (once a week, once a month, by cash, by check, by 
> > 
> >  insurance). Is my preference acceptable to you?
> > *What are your policies about cancellations? Emergencies? Phone  
> > 
> >  calls? Insurance diagnoses?
> > 
> >                            _____________
> >                             Evaluation
> > *After hearing about my reasons for coming, what are your        
> > 
> >  impressions?
> > *How do you see us proceeding? Now? Future directions? Other     
> > 
> >  comments?
> > 
> >                           ------------------
> >                            Sample Contract
> > 
> > ********* agrees to join with ******* each from ******** to
> > *******
> > at *************. During these sessions, each lasting ******
> > minutes, we will direct our efforts toward the following goals:
> > ******************************************
> > ******************************************
> > ******************************************
> > I agree to pay ******* per session for the use of ***********
> > resources, training, and experience as a therapist. This amount
> > payable *******************************. If I am not satisfied
> > with
> > the progress made on these goals, I may cancel any future
> > appointments by giving ************ notice, or ****************.
> > If
> > I miss a session without ********* forewarning, I am financially
> > responsible for that missed session, exceptions to this
> > arrangement
> > being unforseen and unavoidable accident or illness.
> > 
> > At the end of ****** sessions, *************** and I agree to
> > renegotiate this contract. We include the possibility that the
> > stated goals will have changed during the ********** period. I
> > understand that this agreement does not guarantee that I will
> > have
> > attained these goals, however, it does constitute an offer on my
> > part to pay ********* for access to her/his resources as a
> > therapist and her/his acceptance to apply all those resources as
> > a
> > therapist in good faith.
> > 
> > I further stipulate that this agreement become a part of the
> > record
> > which is accessible to either party at will, but no other person
> > without my written consent. The therapist will respect my right
> > to
> > maintain the confidentiality of any information communicated by
> > me
> > to the therapist during the course of therapy. I give/do not give
> > my permission to ********* to audiotape sessions for her/his
> > review. However s/he will not publish, communicate or otherwise
> > disclose without my written consent any information which
> > pertains
> > to me.
> > 
> > ***********************               **********************
> > Client Signature                    Therapist Signature
> > Date ****************** 
> > 
> 
>