Counseling Contract:

Welcome to the first step in creating the life you want to live. Please read the following and become familiar with the guidelines.

Terms of Counseling:

Counseling is a process. For some the process may be short, for others it may be longer. 

While it is not concrete, expect the counseling relationship to last at least 3 months to 12 months. 

Fees:

The counseling session fee is to be paid online via the PocketSuite app. A generated session invite, notification, invoice, and receipt will be emailed and texted to your given information. If you would like to set up autocharge please let the counselor know. There is no commitment beyond month to month. Two weeks' notice is required if you think you will be ending counseling all together. 

Please note that a "month" may not always correspond to a calendar month, but could refer to one set of counseling sessions, that usually takes about a month to complete. 

Administrative Fees

In addition to fees for clinical services, clients may incur administrative fees for non-clinical services that require the clinician’s time and expertise. These services fall outside the scope of routine therapeutic care and may include, but are not limited to:

• Preparation of treatment summaries or letters at client request
• Coordination or completion of third-party forms (e.g., disability, employment, legal)
• Time spent responding to legal inquiries or court-related matters
• Participation in legal proceedings, including but not limited to court appearances, depositions, and consultations with attorneys
• Extensive phone consultations (beyond 15 minutes) with clients or third parties
• Record preparation or transfer beyond routine requests
• Other non-clinical administrative tasks requiring significant time or documentation

Administrative services will be billed at a rate of $_100_ per hour, billed in 15-minute increments, with a minimum charge of $50_ depending on the nature and scope of the request. A cost estimate can be provided upon request prior to service completion.

Court-related services, including preparation, communication, and attendance, are billed at a separate rate of $1,500_ per hour, with a minimum half-day (4-hour) charge for court appearances, regardless of whether the therapist is called to testify.

Clients will be informed when such fees apply, and consent for services will be obtained prior to any administrative work being performed.

Additional Items to Consider Including Under Administrative Fees:

• Rush Requests
• For documentation (e.g., letters, forms, records) needed within 48–72 business hours.
• Add a surcharge or state that rush delivery is not guaranteed.
• Record Review Time
• Time spent reviewing a client’s previous records or collateral documents (e.g., school, medical, or past therapy records).
• Often required when coordinating care or writing legal documents.
• Insurance-Related Documentation
• Time spent on prior authorizations, appeals, or providing clinical summaries for insurance reviews (especially for out-of-network clients).
• Clarify that this is not always covered by session fees.
• Case Coordination
• Extended contact with other providers (e.g., psychiatrists, schools, social workers), especially if it exceeds a quick email or phone call.
• Include this as billable if it’s more than 15 minutes.
• Consultation with Attorneys or Guardians
• Any communication or documentation shared with lawyers, GALs (guardian ad litem), or custody evaluators.
• State that client consent is required unless subpoenaed.
• Phone Calls and Written Communication
• Non-therapeutic phone calls, emails, or letters to the client, family members, or others that exceed a certain time threshold (e.g., 10–15 mins).
• May also include responding to lengthy messages or client emails requiring clinical reflection.
• Missed Subpoenas / Failure to Notify of Cancellations
• If the therapist prepares or blocks time for court and the hearing is cancelled with little notice, you may still charge a flat rate.
• No-Show / Late Cancellation for Court Appearances
• If you’ve blocked time for court and the party fails to notify or cancels, you may still enforce the minimum charge.



Procedure:

Once you have inquired about counseling you will be given a phone call or text to set up a day and time. After this, you will receive a confirmation text or email with a contract to sign.

Changes:

If you need to reschedule our appointment, please give 24 hours notice.  If you have an emergency or illness, you can reschedule with less than 24 hours notice. If you do not show up for a scheduled session, for any reason, and provide no notice, we will not make up that time. If your counselor needs to reschedule, they will give you at least 24 hours notice as well, barring an emergency or illness. You will be charged for missed sessions that do not comply with the above exceptions.

Between Sessions:

Email your counselor directly: general office email: pioneercounselingstl@gmail.com Text or Call: (314) 254-3223, or use the Pocketsuit app as an encrypted means of communication.

Problems:

If the counselor ever says or does anything that upsets you or doesn't feel right, please bring it to their attention so that it can be resolved as soon as possible. The objective is to have a counseling relationship that is fully open, honest, real and trusting in communication styles. You may also you the Contact methods found on the website.

Counseling Agreement

Counseling

Counselor agrees to partner with the client in identifying and achieving personal and/or professional goals.

Results are not guaranteed. The client will create results by being courageous and determined to place action in their life.

The counselor will devote their time, thoughts, and energy to the client, exclusively. The counselor will always attempt to be available within 24 hours of outside session contact.

A counselor is not a psychologist or physician, and will not provided diagnoses, psychological evaluations, or remedies for medical conditions. If any issues come up that should be handled by a psychologist or physician, the client will be referred to an appropriate professional.

The counselor will bring attentive listening, understanding, belief in the client and commitment to their success. The counselor will challenge the client, offer various perspectives, make requests (including assigning homework), celebrate client wins, and guarantee utmost confidentiality (to the fullest extent of the law, so long as self harm or harming another individual is not exhibited).

Counselors are bound to abide by the ACA Ethical Principles and Code of Ethics. As well as Missouri Counseling Board regulations and statutes.

Statement of Policies, Procedures and Informed Consent

-Online Counseling-

Under US law, an electronic signature satisfies the law. 

This section provides your consent to receive online counseling via electronic interface, which at the client’s choice could be text-based, by telephone, or via video software. Specifically, this means that you agree to the following: 

1) Appointments for online counseling will be made according to the same procedures as in-office appointments. 

2) Charges for online counseling will be billed at the same rate as in-office sessions, and the client’s obligation for payment is the same as in-person sessions. 

3) online counseling sessions will only be scheduled and confirmed after an agreed online counseling method has been determined. If the client has no experience with the video software to be used, a pre-test is recommended 

4) Client understands that counselor will use standard email and text, conventional phone lines, and as well as client preference in emergencies such as Apple’s FaceTime and Skype for video conferencing. Client affirms that he/she recognizes the inherent limitations of these technologies and agrees to hold harmless Pioneer Counseling and its counselors /partners from any liability in the unlikely event anyone should electronically eavesdrop or record any portion of client’s sessions. Client assumes responsibility for arranging his/her appointment time in a way that assures privacy during the scheduled session time. Pioneer Counseling EHR and google based features do have a BAA through Google.

5) Client accepts and acknowledges that Pioneer Counseling Statement of Understanding of Limits to Confidentiality fully applies in all respects to all forms of counseling/ therapy 

6) Client acknowledges that he/she understands and accepts each of the provisions stated here by initialing each provision above and by signing below. 

7) When signing this document, client may ‘sign’ electronically by following this format:

 First line represents validation of signature. Second line has typed name

Client

I am motivated and committed to taking action on my determined personal and professional goals. I realize that anything less than my intentional full participation will not lead to my success.

I accept full responsibility for myself and any actions I take that might result from therapy.

I am under the care of a physician and healthy enough to engage in counseling.

I can financially afford the counseling fee at this time. I agree to pay (or be autocharged) promptly by the first of the month for that month's fee. I agree that ultimately, it is my responsibility that my counselor is paid for the services rendered.

I agree to honor my scheduled session times.

I have read and agree with the Counseling Guidelines and the Counseling Agreement.

Click the "Intake Form" button below. Once Submitted we will reach out to you for scheduling.