Open Path Healing Arts Collective Client Financial Agreement Form Name First Name Last Name You agree to obtain an Open Path Healings Arts Collective Membership and will provide email documentation of your Member ID prior to the first session. If you are new to the Healing Arts Collective, complete the following if you have not already: Client Registration. Be sure to pay the one-time $49 membership fee in addition to submitting your registration form. Provide your Open Path Healing Arts Collective Member ID: ___________ Please note, if you already have an Open Path Psychotherapy Collective membership, you must purchase a separate membership for the Healing Arts Collective. Agree Disagree We have made an agreement to an adjusted Open Path Healing Arts Collective Membership rate of $50/hour. This arrangement will be revisited on January 1, 2024, to determine if financial assistance is still needed and/or if the practitioner is still able to continue this arrangement. Agree Disagree Unless other arrangements have been made in advance, if you miss or do not schedule appointments for three consecutive weeks without any communication, for legal and ethical reasons, I must consider the professional relationship discontinued. I may then offer the Open Path Healing Arts Collective spot to another individual in need. If you wish to resume services, I may or may not have a spot available at the previously established rate, so we would be creating a new arrangement. Agree Disagree Any phone conversation over 10 minutes will be charged at a prorated fee based on $50/hour. Agree Disagree Cancellations are required 24 hours in advance. Any appointments scheduled but not kept, as well as any appointments cancelled within 24 hours of scheduled time will be charged $50. We ask that you give at least 24 hours’ notice if you need to cancel or reschedule your appointment due to your (or your child’s) illness. If you have a contagious illness (or if your child has a contagious illness and you are not able to find child care), we ask that you do not come to your appointment. Video conferencing is available if you are not able to come to the office. Agree Disagree Thank you!
