I, the undersigned patient, visitor, person hereby provide my informed consent to engage in mental health services with Mental Help Inc. referred to as “Organization”. I understand and agree to the following terms and conditions:
Terms and Conditions
- Purpose and Nature of Consultation: I understand that the purpose of the consultation is to receive mental health services from “Organization”. These services may include, but are not limited to, assessment, diagnosis, treatment planning, counseling and psychotherapy.
- Confidentiality: I understand that all information shared during the consultation will be kept confidential to the extent allowed by the governing laws of the Republic of the Philippines and their respective professional ethics. The records are confidential documents and will only be available to authorized staff. The “Organization”, will not disclose any information without my written consent unless legally required to do so. However, I acknowledge that there are exceptions to confidentiality, which include situations where the professional determines that there are risks of harm to myself or to others, cases of suspected abuse or neglect, or as mandated by a court order.
- Rights and Limitations: I understand that I have the right to express concerns, ask questions, and participate pertaining to my mental health care. I also acknowledge that the “Organization” have the right to terminate the consultation if my behavior is deemed inappropriate, disruptive, or poses a risk to the professionals and the organization’s safety, or the therapeutic process.
- Treatment Risks and Benefits: Engaging in mental health consultation involves exploring personal and sensitive topics, which may evoke emotional discomfort or distress. It is important to recognize that seeking mental health services can also lead to significant benefits, including personal growth, enhanced coping skills, and improved overall well-being. I understand that our collaborative efforts aim to navigate these obstacles and promote positive outcomes. Work diligently to address any potential risks while maximizing the therapeutic benefits, ultimately striving towards your holistic health.
- Professional Boundaries and Code of Conduct: I understand that “Organization” are composed of professionals who will maintain appropriate professional boundaries during the consultation and beyond consultation. The “Organization” will adhere to the ethical guidelines and code of conduct established by their professions.
- Duration and Frequency of Consultation: The duration and frequency of our consultations will be tailored to meet my individual needs. Together, we will determine the most suitable schedule of frequency and duration for our sessions, considering factors such as the nature of your concerns, treatment goals, and personal circumstances.
- Financial Responsibility: I acknowledge my responsibility for the financial costs associated with consultation services. The “Organization” will provide transparent information regarding fees and payment options, ensuring clarity and understanding from the outset. Payment for services rendered is due at the time of each appointment. Our goal is to prioritize your access to quality mental health care while fostering a collaborative and supportive partnership throughout our therapeutic journey together.
- Cancellation and Rescheduling: I understand that it is my responsibility to provide at least a 24-hour notice for cancellations or rescheduling of appointments. Failure to provide adequate notice may result in a fee or forfeiture of the appointment.
- Termination of Services: I understand that either party has the right to terminate the consultation at any time. If the professional determines that the consultation is no longer beneficial or appropriate for my needs, they will discuss this decision with me and provide appropriate referrals for continued care.
- Marketing and Communications: I understand and agree that by engaging with Mental Help Inc., I may receive emails and newsletters containing mental health tips, updates on services, upcoming webinars, outreach programs, certification opportunities, and other relevant information. I acknowledge that these communications aim to support my mental well-being and keep me informed about helpful resources. I may opt out of these communications at any time by following the unsubscribe instructions provided in the emails.
No-Show Policy
We recognize that unexpected events can occasionally cause delays. However, it’s crucial to acknowledge that tardiness can disrupt schedules, consultations, and the experience of other clients. In respect of everyone’s time, if you arrive late for your appointment, your session will be adjusted to accommodate the remaining duration of your originally scheduled time upon the professional discretion of the assigned clinician.
In the event of a missed appointment without prior notice, a fee equivalent to 100% of the service price will be incurred. We appreciate your understanding and cooperation in adhering to our scheduling policies, which allow us to maintain the efficiency and quality of our services for all clients. Should you have any questions or concerns regarding this policy, please feel free to reach out to our team for clarification.
Cancellation Policy:
We understand that unforeseen circumstances may arise, necessitating changes to your scheduled appointment. To accommodate your needs, we offer the option to reschedule appointments at no additional cost, provided that the request is made at least 24 hours prior to the scheduled time.
However, in the event of a cancellation or rescheduling with less than the aforementioned notice, a fee equivalent to 100% of the scheduled service price will be applied. This policy enables us to effectively manage our schedule and accommodate the needs of all our clients.
We appreciate your cooperation and understanding regarding our cancellation policy. Should you have any questions or require further assistance, please do not hesitate to contact us.
No Harm Agreement
I, the undersigned patient, fully aware of my situation, hereby agree to the following:
I commit to abstaining from all forms of self-harm, including suicide and self-mutilation.
I pledge to contact my mental health professional before engaging in any act of self-harm.
I will seek help and support whenever I experience the compulsion, strong desire, or need to harm myself in any way, including thoughts of suicide, self-mutilation, or accidental harm.
In times of overwhelming distress or suicidal ideation, I understand that immediate assistance is crucial. Therefore, I acknowledge the availability of the following crisis hotlines:
National Center for Mental Health Crisis Hotline: 0966-351-4518 / (02) 8531-9001
I understand that Mental Help Inc. shall not be held responsible or assume liability for any injury or death resulting from my actions.
I affirm that these conditions are vital and worthy of commitment, and I willingly enter into this contract. By my word and honor, I intend to uphold this agreement.
By Continues use of the website, I acknowledge that I have read, understood, and agrees to the terms and conditions of the consultation. I also acknowledge that my typed name constitutes as legal and my digital signature.