Estevam C. Holpert, M.A.
230, Antonio Devair Pinheiro, Campos Eliseos, Brotas-SP, Brazil
CPF 280.913.848-66
CRP 06/65.368, e-psi 219.567
website: psicologoclinicoonline.com.br
Psychological Services Contract
Welcome to my practice. This document contains important information about my professional services and office policies. In accordance with the Brazilian Psychology Council (https://site.cfp.org.br/) and the Psychology Council of São Paulo (https://www.crpsp.org/), this contract describes some prerequisites, limitations and the routine of my online sessions, confidentiality concerns, fees, cancelation and missed appointments procedures and other issues. Therefore, before scheduling an appointment, make sure you read and understand this document thoroughly and, if necessary, contact me for further elucidation. When you sign this document, it will represent and agreement between us.
Psychological Services – Psychological services are not easily defined in general terms, and their development and success depend greatly on the trust built between the psychologist and the client. Unlike a medical doctor visit, for example, it calls for an active effort on both parts. As this relationship advances, it is expected that the rational underlying the client’s psychological issues become clearer, thus allowing change to take place. However, the prospect of giving up old habits often brings feelings of vulnerability, anger, sadness and anxiety, which need to be managed in the process, making progress inconstant. Although there are no guarantees that specific objectives will be achieved, the client’s psychological wellbeing and general happiness guide the psychologist’s work all along.
Prerequisites and scope – As my services develop entirely online, it is important that clients are acquainted to the use of computers, tablets or mobile phones and video calls as a means of communication. If the client feels too uncomfortable or unable to manage this technology, the psychologist can interrupt or terminate the service and refer the client to an on-site health facility. Also, clients must be at least thirteen years of age to take part in my services. In accordance with the Brazilian Psychology Council policy, clients will also be referred to an on-site health service or to a specialized professional in case of severe or urgent mental issue or in case of manifest violation of rights.
Duration – Once we start, we will decide on a regular schedule of meetings, usually at least once a week. In general, more frequent sessions contribute to the progress of the psychological work, while absences and pauses hinder it. Each session lasts sixty minutes, but they can be extended or reduced according to their development and demands, for the same fee. The client may decide to discontinue the process at any time, free of charge or obligations of both parties. However, considering the impact on the client’s psychological wellbeing, it is recommended that this decision is discussed with the psychologist in advance.
Confidentiality – My psychological services include open discussions of private and difficult issues, so confidentiality is paramount. In accordance with the Ethical Code of Conduct for Professional Psychologists in Brazil (https://site.cfp.org.br/wp-content/uploads/2012/07/codigo-de-etica-psicologia.pdf), the disclosure of personal information might occur when formally authorized by the client, when it is required by a legal court, if there is the threat of imminent harm to the client or third parties, or in cases of manifest violation of rights. It is strictly forbidden to record the whole or part of the psychological sessions in video, audio, image or message, by any means, under penalty of the sanctions provided for by law. In order to guarantee the security of the information exchanged, clients are required to keep computers, tablets and cellphones used during my psychological services up to date with their antivirus and firewall software, and the exchange of videos and messages must be encrypted end-to-end by the software provider (such as on Whatsapp and Skype, for example). Similarly, clients must be set in an intimate, safe and calm physical environment for the sessions to take place.
The storage of the sessions’ records – According to the Brazilian Psychology Council, the records made during the psychological services should be kept safe by the psychologist for at least five years. During this period, the client has the right to access his or her personal files at any time, once the services are terminated.
Fees – My fee for each session is $35 USD. It must be paid by the client at least 24 hours before the scheduled session by bank transfer, debit or credit card (PagSeguro or PayPal).
Missed or Cancelled Appointments – If the client informs the psychologist about the cancellation at least 24 hours before the beginning of the session, it can be rescheduled, or the amount paid for that session will be reimbursed. The fee for a missed appointment or a late cancellation is the same as for a regular session. In case of late attendance, there will be no compensation or reimbursement for the time missed.
Minors and Parents – In case of clients between 13 and 17 years of age, the ‘Authorization for Online Psychological Services to Adolescents’ must be completed signed by at least one of the parents or legal guardians.
Your signature below indicates that you have read this contract and agree to its terms. Upon signing this contract, you are choosing to enter into a professional relationship with Estevam C. Holpert, M.A., for the purpose of obtaining psychological services.
Brotas, XX de XX de 2021.
PSYCHOLOGIST:
________________________________
ESTEVAM COLACICCO HOLPERT.
CLIENT:
________________________________
XX
