Please read the following information carefully. It is your responsibility to understand the conditions of establishing a counseling
agreement prior to entering into the counseling relationship. Continuing into the counseling relationship is considered your
acceptance and understanding of these terms. Should you have any questions concerning this agreement, please call or e-mail
my office.
Andrew Bock, MS, LPC, is established as an individual in private counseling practice in the city of Budapest, Hungary. Ethical
responsibilities are also recognized through membership in the American Counseling Association. For purposes of this
agreement, Andrew Bock, MS, LPC will be referred to as "counselor" and the individual seeking counseling services will be
referred to as "client".
All clients engaging in any form of counseling relationship, must be 18 years of age or older, unless accompanied by a parent
during the initial meeting.
Privacy & Confidentiality:
All communications are conducted in a private setting and held in strict confidence. Information shared can not be released by
the counselor to anyone except for the follow exceptions: (1) A client reveals the thoughts or plans to harm themselves or others.
(2) Reveals any situation that may be considered abuse or danger to a child or elderly individual. (3) Any legal issues involving
the client that results in demand for information as per a court order, (4) With clients written consent.
Evaluation for Services:
Prior to setting an appointment, ideally each client will provide as much information as possible, so counselor may briefly
evaluate clients needs. This can be done by telephone or e-mail. The purpose is to establish the client's needs and
appropriate mode of services. There is no charge for this exchange of information.
Fee Agreement:
Fees are to be paid 4 (four) sessions in advance to services provided. (1) Cash may be used as payment for office visits.
USD/EUR/HUF are accepted.
Insurance Provider:
The client is asked to self-pay and file with his/her insurance company for reimbursement. Responsibility for payment rests
with the client.
Missed or Canceled Appointments:
Client agrees to cancel appointments at least 24 hours in advance. Clients not giving proper cancellation notice, will be charged
the entire fee for each missed appointment.
Fee Refunds:
Refunds will be given for the following reasons:
Referrals for Additional Services:
Occasionally the client may need additional services not offered by counselor. Counselor will provide client with referrals if
possible. However, client holds the responsibility and risk for contacting and accepting these services and their outcomes.
Termination of Services:
Client or counselor may choose to terminate the counseling relationship at any time. The party choosing to terminate the
relationship, agrees to contact the other party through e-mail or written letter, with reasons for termination. Client may choose to
terminate the counseling relationship at anytime. Counselor may terminate relationship if they feel the client has reached their
goals, the client is not progressing under the counselors care, or the counselor is not qualified to provide the services needed at
this time. Counselor agrees to provide client with referrals for more appropriate services should this be needed.
By making arrangements to use the counselor’s services, you are agreeing to all conditions stated in this policy.
agreement prior to entering into the counseling relationship. Continuing into the counseling relationship is considered your
acceptance and understanding of these terms. Should you have any questions concerning this agreement, please call or e-mail
my office.
Andrew Bock, MS, LPC, is established as an individual in private counseling practice in the city of Budapest, Hungary. Ethical
responsibilities are also recognized through membership in the American Counseling Association. For purposes of this
agreement, Andrew Bock, MS, LPC will be referred to as "counselor" and the individual seeking counseling services will be
referred to as "client".
All clients engaging in any form of counseling relationship, must be 18 years of age or older, unless accompanied by a parent
during the initial meeting.
Privacy & Confidentiality:
All communications are conducted in a private setting and held in strict confidence. Information shared can not be released by
the counselor to anyone except for the follow exceptions: (1) A client reveals the thoughts or plans to harm themselves or others.
(2) Reveals any situation that may be considered abuse or danger to a child or elderly individual. (3) Any legal issues involving
the client that results in demand for information as per a court order, (4) With clients written consent.
Evaluation for Services:
Prior to setting an appointment, ideally each client will provide as much information as possible, so counselor may briefly
evaluate clients needs. This can be done by telephone or e-mail. The purpose is to establish the client's needs and
appropriate mode of services. There is no charge for this exchange of information.
Fee Agreement:
Fees are to be paid 4 (four) sessions in advance to services provided. (1) Cash may be used as payment for office visits.
USD/EUR/HUF are accepted.
Insurance Provider:
The client is asked to self-pay and file with his/her insurance company for reimbursement. Responsibility for payment rests
with the client.
Missed or Canceled Appointments:
Client agrees to cancel appointments at least 24 hours in advance. Clients not giving proper cancellation notice, will be charged
the entire fee for each missed appointment.
Fee Refunds:
Refunds will be given for the following reasons:
- Client gives at least 24 hours notice to cancel prepaid appointment.
- Counselor fails to keep the appointment.
Referrals for Additional Services:
Occasionally the client may need additional services not offered by counselor. Counselor will provide client with referrals if
possible. However, client holds the responsibility and risk for contacting and accepting these services and their outcomes.
Termination of Services:
Client or counselor may choose to terminate the counseling relationship at any time. The party choosing to terminate the
relationship, agrees to contact the other party through e-mail or written letter, with reasons for termination. Client may choose to
terminate the counseling relationship at anytime. Counselor may terminate relationship if they feel the client has reached their
goals, the client is not progressing under the counselors care, or the counselor is not qualified to provide the services needed at
this time. Counselor agrees to provide client with referrals for more appropriate services should this be needed.
By making arrangements to use the counselor’s services, you are agreeing to all conditions stated in this policy.
| PROFESSIONAL AGREEMENT |
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| Andrew Bock, MS, LPC |
| © Andrew Bock 2007 All Rights Reserved |