Acknowledgement of Services and Fees

Subject: Self-Improvement Program

I, the undersigned, hereby acknowledge and agree to the following terms regarding the self-improvement program:

  1. I agree to pay Cassidy York a fee of $150 per session. This fee is payable in full at the time of each session.

  2. I understand that all cancellations or appointment changes require at least 24 hours' notice. Failure to provide this notice, or missing a scheduled appointment, may result in a charge at the current full session rate.

  3. I acknowledge that the number of private sessions required will depend on my individual needs. The program is designed for vocational or avocational self-improvement. I understand that issues of a psychogenic or functional origin will be referred to appropriate psychological or medical professionals as per Business and Professions Code 2908.

  4. Either party, myself or the therapist, may choose to initiate or terminate the therapy relationship at any time, without the need for detailed explanations.

  5. I understand that while every effort will be made to achieve the objectives of my sessions, no guarantees can be provided regarding specific outcomes or progress.