Client Therapy Agreement
OF SOUND MIND LLC · ADULT INDIVIDUAL THERAPY
Review the Client Therapy & Telehealth Agreement before beginning services. It explains the therapy relationship, fees, appointments, privacy, telehealth risks, emergency arrangements, and your choices.
Read and sign your agreement
The complete agreement will open in Jotform for you to review and sign electronically. You sign as the client; Dr. Mirfat Addi reviews and countersigns separately. Please ask any questions before signing. A completed copy will be provided after the signing process is complete.
Read and sign the Client Therapy Agreement →
Self-pay fees
15-minute intake consultation: $24.00
One-hour video therapy session: $149.99
30-minute video therapy session: $74.99
One-hour phone therapy session: $124.99
Payment is due at booking. Insurance benefits and your out-of-pocket responsibility depend on your specific plan and service and are confirmed before treatment. These self-pay rates are not an insurance copayment quote.
Appointments and communication
Cancel or reschedule at least 24 hours before your appointment. Missed appointments (no-shows) incur a $50 fee, subject to applicable law and payer requirements.
I respond to routine messages within one business day. Contact me at 504-438-6275 or maddi@ofsoundsmind.com. Please avoid sensitive health details in public forms or ordinary email/text.
Telehealth and your location
Individual video or phone therapy is available when clinically appropriate and permitted for clients physically located in California, Louisiana, and Florida. Confirm your location and callback number at each session, and discuss travel or relocation before your appointment. Use a private, safe setting and do not drive during sessions.
Privacy, safety, and connection problems
The full agreement explains confidentiality and its legal limits, technology and privacy risks, emergency planning, and alternatives to telehealth. If a video connection fails, try to reconnect. If you cannot reconnect within five minutes, call 504-438-6275; I will also attempt to call the callback number you provided.
This practice does not provide 24-hour emergency coverage. Do not wait for a routine message response in an emergency. Contact local emergency services or go to the nearest emergency department.
Before services begin
This agreement is for adults age 18 and older receiving individual therapy. Support groups and LPC supervision have separate arrangements. Reading this page or signing an agreement does not guarantee availability or begin treatment by itself. We will confirm suitability and complete the required intake and consent process before services begin. Contact me if you need a paper or accessible signing alternative.