Individual Consultation Agreement

Agreement. Individual Consultative Supervision

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Your Name (required) *

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Your Email Address (required) *

Date of Agreement: Individual Consultative Supervision *

Introduction
This agreement must be completed on-line and submitted prior to the initiation of individual consultative supervision. It may be withdrawn at any time. There are three agreements in this document:

1. Nature of consultative supervision
2. Personal liability
3. Payment for service

Your completion and submission of this document indicates your agreement with its terms.

Feel free to email me with any questions: philrich@philrich.net

1. Nature of Consultative Supervision
I understand and agree that supervision provided by Dr. Phil Rich is of a consultative nature, and that Dr. Rich does not assume any responsibility for the actions and choices made by any consultee during the course of his or her practice, nor holds or accepts any clinical, administrative, or oversight responsibilities for the caseload of any consultee.

I have read the above paragraph and understand that Dr. Rich provides consultative supervision and is not responsible for my work actions and decisions with respect to my caseload and all other aspects of my practice at all levels, nor provides any level of administrative or clinical oversight for any of my cases.

1. Nature of Individual Consultative Supervision *

I understand and agree I disagree

2. Personal Liability
Phil Rich does not accept liability or responsibility for the quality and performance of the clinical or related work of any consultee. Consultees are fully responsible for their own choices and the manner in which they apply ideas discussed during consultative supervision.

I understand and agree that entering into this contractual relationship for consultative supervision does not hold Phil Rich responsible in any way for the quality or application of my clinical or related work.

2. Acceptance of Personal Liability: Individual Consultative Supervision *

Understand and agree Disagree

3. Payment for Services
I understand that there is a fee to pay for each session, and that I am expected to pay for sessions within 5 days of the session. Payment must be made by PayPal or by other agreed upon means and at the fee established through email correspondence.

I have read the above paragraph and understand there is a per session fee to be paid within five days of each session, and agree with these terms.

3. Agreement for Payment: Individual Consultative Supervision *

Understand, and agree Disagree

Please hit the "Submit" button to submit your Participation Agreement, or email me with any questions.

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