Narelle Williams | ACA Membership # 3519

Clinical Counsellor, Family Therapist, Advanced Grief Recovery Specialist & Clinical Supervisor
Bethesda Counselling & Family Therapy, Suite 1, No 14 The Avenue, Midland, 6056 WA

Therapy Agreement Form

I understand that my counsellor will help me to understand myself, help me clarify my problems, goals and objectives, and help me look at alternative solutions to my issues. I further understand that I am fully responsible for the decisions I make concerning my life and behaviour.

I understand that the model of therapy used looks at the past and the present. It considers my family-of-origin, feelings, thought patterns and communication skills, all having in view personal and family restoration to wholeness. It is designed to help me focus on achieving optimum health, encouraging me to seek and find an enriching and fulfilling life. I also acknowledge and understand that my counsellor has a biblical worldview.

I understand that I am personally responsible to pay for all therapy provided for me and my minor children (if applicable) at the time of the service.

  • When an appointment is made, this represents an allocation of the therapist’s time, therefore I authorise Bethesda Counselling and Family Therapy to charge 100% of the standard fee when I fail to give 24hours notice of cancellation (not including weekend days). I am aware that there is no charge if more than 24 business hours notice is given.
  • All information that is an integral part of the counselling provided is confidential. However, there are times when the counsellor may ask you to tell someone about things that have happened, ask your permission to speak to someone, or may inform you that it is required to tell someone:

– If the therapist is required to provide evidence for a court or other legal hearing.

– When in the therapist’s professional opinion some harm could come to you or another person.

– When you mention that you witnessed or committed a serious crime.

– If the information may prevent a crime from being committed.

– When you have evidence or suspicion of abuse of someone who is still a minor

  • I also understand that the counsellor will not do court reports. A fee may be charged for letters.

Please sign below to show that you have read and understand the things written above:

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Narelle Williams | ACA Membership # 3519

Clinical Counsellor, Family Therapist, Advanced Grief Recovery Specialist & Clinical Supervisor
Bethesda Counselling & Family Therapy, Suite 1, No 14 The Avenue, Midland, 6056 WA

Therapy Agreement Form

I understand that my counsellor will help me to understand myself, help me clarify my problems, goals and objectives, and help me look at alternative solutions to my issues. I further understand that I am fully responsible for the decisions I make concerning my life and behaviour.

I understand that the model of therapy used looks at the past and the present. It considers my family-of-origin, feelings, thought patterns and communication skills, all having in view personal and family restoration to wholeness. It is designed to help me focus on achieving optimum health, encouraging me to seek and find an enriching and fulfilling life. I also acknowledge and understand that my counsellor has a biblical worldview.

I understand that I am personally responsible to pay for all therapy provided for me and my minor children (if applicable) at the time of the service.

  • When an appointment is made, this represents an allocation of the therapist’s time, therefore I authorise Bethesda Counselling and Family Therapy to charge 100% of the standard fee when I fail to give 24hours notice of cancellation (not including weekend days). I am aware that there is no charge if more than 24 business hours notice is given.
  • All information that is an integral part of the counselling provided is confidential. However, there are times when the counsellor may ask you to tell someone about things that have happened, ask your permission to speak to someone, or may inform you that it is required to tell someone:

– If the therapist is required to provide evidence for a court or other legal hearing.

– When in the therapist’s professional opinion some harm could come to you or another person.

– When you mention that you witnessed or committed a serious crime.

– If the information may prevent a crime from being committed.

– When you have evidence or suspicion of abuse of someone who is still a minor

  • I also understand that the counsellor will not do court reports. A fee may be charged for letters.

Please sign below to show that you have read and understand the things written above:

MM slash DD slash YYYY
Terms and Conditions*