Treatment Compliance Contract

I,

understand that I am responsible to attend all appointments for the next 30 days. Any cancellations on my part must be provided within at least 24 hours advance notice of my appointment time and date. I understand if I cancel an appointment my therapist may not be able to accommodate a request to reschedule within the same week. I understand that if I miss more than 1 psychotherapy sessions in a calendar month, even if it is cancelled 24 hours in advanced, it may result in termination of all services with Suffolk Family Therapy LCSW P.C. In signing this form I indicate I have read and understand the above Treatment Compliance Contract and agree to all terms and conditions set forth by Suffolk Family Therapy LCSW P.C. *

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Treatment Compliance Contract

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Call: 631-503-1539

4109 Sunrise Highway Bohemia, New York 11716