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Richard R. Boersma, M.S.
810 Lincoln, P.O. Box 240, Steamboat Springs, CO 80477 Voice: 970-879-7637 Fax: 970-871- 6811
Online Counseling Agreement
I understand that:
- my online confidentiality and privacy are assured at the psychotherapy office end, thanks to an encrypted "secure" internet connection. However, I am responsible for internet security at my own end.
- "synchronous" online sessions (when Mr. Boersma and I will be online simultaneously) must be scheduled and adhered to just as conventional office sessions require, so that both parties can rely upon a schedule. Cancellations less than 24 hours in advance may be charged at half-rate.
- "sequential" sessions (communications back and forth are not immediate) do not need to be scheduled, and will be answered within 24 hours.
- Richard Boersma, M.S., will maintain a printed summary of our online communications in a confidential physical file in his office.
- Mr. Boersma may not always be available to me at all hours, although he will provide phone numbers for me to use for backup contact. Should I experience a personal emergency and be unable to reach him, I will contact emergency services (call 911).
- the fee for synchronous online counseling is $50 for a 25 minute session and $80 for a 55 minute session.
- the fee for sequential (non-synchronous) online counseling is assessed by Mr. Boersma per response, and I have the right to adjust this fee according to my own estimate of value. My decision will be final and will be respected as fair by all.
- health insurance plans do not pay for online mental health counseling services, and no billing will be sent to my insuror by Mr. Boersma’s office.
- I must provide valid credit card information when beginning online counseling, as a backup payment measure. However, I can pay for billed services by any method I desire: cash, check, or credit card.
- I am under no obligation to continue online counseling (or any therapy arrangement). I can suspend or discontinue counseling at any time, but will inform Mr. Boersma of my desire as a courtesy.
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