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INTAKE & CONSENT FORM

Please complete our intake form, and then read through our consent form at the bottom in order to confirm your appointment.

Medical Aid Clients

Our session fee is R1,030 (inclusive of VAT) per session, (51 - 60) minutes.

Please provide your medical aid details below, so that we can check if you have funds available before your session. We will notify you IF this information is available.

Medical aid clients are liable to pay an admin fee of R170 (inclusive of VAT), and is payable upon submitting this form, in order to confirm your session.

 

Please Note: This admin fee is not covered by your medical aid.

Please Note: The medical aid check is subject to available funds at the time of your session. Should your savings be depleted beyond full coverage before your session, you will be liable for the fee balance NOT covered by your medical aid.

 

INTAKE FORM

DATE OF APPOINTMENT

SESSION STYLE

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THERAPY TYPE

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PAYMENT METHOD

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CLIENT INFORMATION

Client/Partner 1

Client/Partner 2

PERSON/GUARDIAN RESPONSIBLE FOR ACCOUNT

(If Not Client)

MEDICAL AID DETAIL

(If Not Cash)

NEXT OF KIN

(In Case Of Emergency)

CONSENT FORM

INFORMED CONSENT FOR PSYCHOTHERAPEUTIC SERVICES

Welcome to Psych Central. This document contains important information about our professional services and business policies. Please read it carefully and note any questions you might have so that it can be discussed with your therapist. When you sign this document, it will represent an agreement between you, your therapist and Christel Roets Psychologist and Partners Inc. T/A Psych Central.

 

PSYCHOLOGICAL SERVICES

Psychotherapy is not easily described in general statements. It varies depending on the personalities of the psychologist and client, and the particular problems you bring forward. There are many different methods that can be used to deal with the problems that you hope to address. Psychotherapy calls for a very active effort and commitment on your part. Since therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. On the other hand, psychotherapy has also been shown to have benefits as it often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress. But there are no guarantees of what you will experience. There is no fixed recipe or structure to be followed in therapy and thus it is a very individualized process that will change as your needs does.