Fee Schedule Consent Form

Agency Funded Services

Fee Schedule Consent Form - Agency Funded Services

Terms of engagement:

I have received a copy of the fee schedule for “Play Therapy with Millie” and consent to paying this fee on a weekly basis for the ongoing booking of this child

There is no contract where you are ‘locked-in’ to a certain time frame; however, we do ask where possible the family give at least 1 weeks’ notice if family will be terminating our services. If we feel we can no longer offer this child our services, we will advise you with as much notice as possible.

Some families engage for a short-term intervention (6-8 weeks) and others may use these services for several years. However, we do ask that you keep communication open around the length of time you think you will be engaged in therapy/support sessions if you know in advance. This supports us to communicate with the child during our sessions how many we have left to prepare them for change. Notice of ending therapy/services also allows us to advise families on our waitlist how long we think they may be waiting for a booking with us.


Cancellation:

I am aware and acknowledge that if the child is unable to make their session, I will need to inform the business as early as possible, or I will still be required to pay a fee. A text is sent to the parent/guardian mobile 24 hours in advance for you to confirm booking.

If the business is not informed 48 hours prior to the child’s session of an absence, you will be charged at the full rate of service.


Payment:

We require fees be paid as invoices are issues and we require 1 week of services to provided prior to commencing ongoing bookings with us. Payment of services are due within 5 days of receiving your invoice. Any queries about the fees or what is on your invoice please email: accounts@playtherapytas.com.au


Referral Form

WeTransfer Consent Form for Video Uploads

Therapist name: Millie Evans

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