CONSENT FORM
constanza rosemary, M.Sc. (A), n. d. psychospiritual therapist
naturotherapy registration #18-6339
infinite gratitude to the people of tiohtià:ke, hupacasath, and tseshaht for allowing me to live, play, and work on their land.
SAFETY & CONFIDENTIALITY
any information exchanged during sessions will remain strictly confidential. there are 3 exceptions to this, including:
● if i have reason to believe that you are in clear and imminent danger of harming yourself or another person;
● if i learn that a minor is being harmed;
● if i am mandated to do so by a judge.
SESSIONS
sessions are 50 minutes in length and are usually scheduled on a weekly basis, although it may sometimes be appropriate for sessions to be less frequent. therapy may be short or long term depending on your needs. together we will co-create a therapeutic rhythm and pacing that is catered to your own individual needs and resources.
during our sessions i:
-offer a non judgmental space fueled by unconditional love
-provide my clients with deep and undivided presence and witnessing
-ask questions to facilitate clarity and understanding
-reflect back to you what i am hearing in my own words
-bring awareness to certain limiting beliefs or narratives
-offer psychoeducation on the healing process and our innate power as humans
-hold you accountable to your own growth
-remind you of the power of your word, thoughts, and beliefs
-convey any message or downloads i might be intuitively called to share
-co-create a customized 'home-practice'
at the end of every session, we might agree on a home-practice, which is a customized exercise catered specifically to your own growth journey. your level of commitment to this practice will determine the level of success and inner peace/transformation you will experience in your life.
should you wish to conclude or take a break from our therapeutic work, i invite you to please let me know, either during a session or via email, for the sake of respect and clear communication. :)
FEES & CANCELLATION POLICY
there are 2 payment options:
1) the first one is the $111 option for people who DO NOT need a receipt.
2) the second one is the $123* option for people who NEED a receipt.
*clients are welcome to pay $136 should they feel abundant, resourced, and generous :)
fees are payable either via etransfer to therapy.constanza@gmail.com or via paypal (if you wish to pay through your credit card).
it is very important that payments are sent the day of the session for auditing and accounting purposes. i recommend sending the payment prior to our session to avoid forgetting afterwards. if you need to cancel an appointment, i request a minimum of 24 hours before the session. this 24-hour window allows me the time to offer the appointment slot to another client who might have requested it. failure to comply with the 24-hour cancellation policy results in a payable fee equivalent to 100% of the total session cost.
if you're late to the session (no worries, it happens!), please make sure to let me know at your earliest convenience. a brief email with the approximate time of delay will suffice. should I not hear from you, i will stay in the video call for a maximum 10 minutes, at which point i will end the call until i hear back from you.
once the session is completed and the payment is received, an online receipt will be sent to the client's email address on file. i offer receipts as a naturotherapist (#18-6339). it is the client's responsibility to inform themselves about insurance coverage and to take charge of that process.
SCHEDULING & COMMUNICATION
i see clients tuesdays and wednesdays at 1pm, 2pm, 5pm, and 6pm EST.
to book sessions please visit: https://tidycal.com/constanzarosemary. our sessions take place exclusively online, via google meets video service. please make sure you have a safe and private space with a solid internet connection. sessions are booked on a ''first come, first served'' basis, unless someone has reserved a weekly or biweekly spot. booking is left to each client's discretion.
communication happens via email (therapy.constanza@gmail.com). please do not text or call my phone number, unless you're unable to type and need to notify me that you're late for our session. should you need immediate assistance please contact your local health authorities and/or dial 911, at your discretion. i am not to be contacted during cases of emergency.
SIGNATURE
by my signature, i acknowledge that i have read and understand this therapy disclosure. i consent to therapy with constanza rosemary, according to the terms described here.