Welcome to my therapy practice. You need to complete all the information above, then click on the tick box, so it is checked - this is at the end of the contract (next to confirm) and hit BOOK MY APPOINTMENT. You will then be taken to my diary. It will hang if you miss any of these steps. Email me at farhanagoga@gmail.com or send me a whatsapp: 0836449338 if you struggle.

This document contains important information about my professional services and business policies. It also contains important information about the Health Insurance Portability and Accountability Act (HIPAA), and POPIA a law that provides new privacy protections and new patient rights with regard to the use and disclosure of your Protected Health Information (PHI) used for the purpose of treatment, payment, and health care operations. HIPAA and POPIA requires that I provide you with a Notice of Privacy practices (the Privacy Policy, and my Terms & Conditions (which includes my disclaimer) for use and disclosure of PHI for treatment, payment and health care operations. The privacy Policy, and my terms & conditions are available on my website and explain how I will use your information in greater detail. The law requires that I obtain your signature acknowledging that I have provided you with this information, when you click that you agree below, that will be representative of your signature.

Although these documents are long and sometimes complex it is very important that you read them carefully before. We can discuss any questions you have about the procedures at our first session. When you sign this document (when you agree at the end), it will represent an agreement between us.

PSYCHOLOGICAL SERVICES.
Psychotherapy is not easily described in general statements. It varies depending on the personality of both the therapist and the patient and the particular problems that the patient brings. There are many different methods I may use to deal with the problems that you hope to address. Psychotherapy is not like a medical doctor visit; it calls for an active effort on the part of the patient. Psychotherapy can aid you in discovering tools and techniques that can be utilized to improve the quality of your life and your relationships. Psychotherapy involves change, which may feel threatening not only to you but also to those people close to you. The prospect of giving up old habits, no matter how destructive or painful, can often make you feel very vulnerable. The process can include experiencing feelings like sadness, guilt, anxiety, anger, and fear and making changes that you did not originally intend. Like any professional service, therapy may not work, and for a relatively small number of people, problems may get worse. Even so, many people find that therapy is worth the discomfort they feel. Therapy often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress. There are no guarantees of what you will experience.

As the patient involved in this process, you have the right to ask me about my professional experience, background, and theoretical orientation. As the therapist, I am offering the following information regarding the therapeutic relationship in response to frequently asked questions.

THE THERAPY PROCESS
Initially, we will meet to evaluate the problems that bring you to therapy and I will give you some

initial impressions of the kind of treatment that would be helpful to you. During the first few sessions, you should be thinking about whether you feel comfortable working with me. Because therapy may involve a substantial commitment of time, money, and energy, it is important that you feel comfortable with the therapist you choose. If you decide that you are not comfortable working with me, I would be happy to help you find another therapist. If you do decide to work with me, we will develop goals and a treatment plan together.

Once psychotherapy is initiated we will decide on a regular schedule of meetings; usually at least one session a week. You may discontinue therapy at any time, though I strongly encourage you to discuss it with me first.

FEES
My therapy sessions are 50 minutes.

My fee is R1600/session. In order for therapy to be effective, weekly sessions are advised.

If you are an existing client, and wish to attend adhoc or once a month, the fee is R1800. This is for "old" clients, who attend adhoc sessions.

Therapy requires regular sessions (even, perhaps especially, when you don't feel like it).​

My fees are subject to increase. If you are a client, I will notify you when I do my increases.

Payment must be made by EFT BEFORE your session. Bank details will be emailed to you.

Therapy is a process and many clients who are looking for personal growth, healing and support choose long term therapy.

Periodically my fees increase due to inflation and cost of living increases. Services provided outside of regularly scheduled appointments such as report writing, preparation of records or treatment summaries, extended phone consultations, and the time spent performing any other service you may request of me are prorated. I do not attend court procedures. If, in the unusual circumstance that you are involved in a legal proceeding that requires my participation, you will be expected to pay for all of my professional time, including preparation and transportation costs, even if I am called to testify by another party. Because of the complexity and difficulty of legal involvement I charge a separate legal fee.

MEDICAL AID
In order for us to set realistic treatment goals and priorities, it is important to evaluate what

resources you have available to pay for your treatment. If you have medical aid, it will usually provide some coverage for mental health treatment. I do not claim from medical aid, and my fees are more than they usually cover. At some point, your medical aid will run out. It is your responsibility to find out exactly what mental health services are covered for you by your insurance policy. If you have questions about the coverage, call your plan administrator. Of course, I will provide you with whatever information I can based on my experience and will be happy to help you in understanding the information you receive from your insurance company.

You should also be aware that most insurance companies require me to provide them with a code number that indicates a clinical diagnosis. The insurance company will sometimes ask for more information including symptoms, diagnoses, degree of impairment, and my treatment methods. This will become part of your permanent medical record. Some of these details are on your statement. Please understand that I have no control over how these records are handled at the insurance company. My policy is to provide only as much information as the insurance company needs to pay your benefits.

This information will become part of the insurance company files. You need to also think through what will happen if they run out before you feel ready to end our sessions. Most therapy takes a minumum of 6 months.

Please note that the insurance contract is between you and your insurance company and the responsibility for your fees is yours. Consequently, disputes concerning coverage must be resolved by you with your insurance carrier.

Unpaid bills may be turned over to a collection agency and/or an attorney and, if so, you will also be responsible for collection and/or legal costs.

MISSED, CANCELLED, CHANGES TO APPOINTMENTS

Changes can be made up to 48-hours before your session. Anything less than that, and without exception, missed, changed or canceled appointments will incur the usual charge.

TIME ZONES

Farhana is in the time-zone SAST, Please check your time-zone and what the timezone recorded is and double check it in SAST. Farhana is not responsible for mistakes based on in-correct times because of your confusion in time-zones.

TELEPHONE CALLS, EMAILS, TEXTS
You can send me a written whats app Mon - Thursday 9am - 3pm. Any other time, please email me. Do not call me or send me voicenotes, unless we have previously agreed.

If you choose to contact

me you are assuming all risks regarding the confidentiality of any information you send. My communications to you will be for scheduling and billing only. Therapy is only conducted in our sessions.

I check my messages periodically

throughout the day and reply calls at my earliest convenience.

If your situation is an emergency, an immediate crisis, please contact life line or go to an emergency room. I do not provide emergency services.

When I am away I do not respond.

CONFIDENTIALITY
Your therapy will include talking over very private things with me. To some extent my ability to

help you will depend on how open you can be about yourself – your ideas, feelings, and actions. So that you can feel free to talk openly with a psychologist and so that your right to privacy is protected. This means that, with some very limited exceptions (some noted below), I cannot reveal information about your to anyone else or send out information about you without your permission. If we become involved in family or couple’s therapy (where there is more than one client), and you want to have my records of this therapy sent to someone, all of the adults present will have to sign a release.

If you ever want me to share information with someone else (for example, your physician), I ask that you sign a written Authorization form that meets certain legal requirements imposed by HIPAA and POPIA. We will talk about this before you sign the consent. There are other situations that require only that you provide written, advance consent. Your signature (YOU TICKING BELOW) on this Agreement provides consent for those activities.

Exceptions to Confidentiality
There are exceptions to confidentiality that you should know about. Please note that while most of

these situations are rare, they are important for you to understand. Exceptions to confidentiality include, but are not limited to, the following:

1. If you threaten to harm someone else, I am required under the law to take steps to inform the intended victim and appropriate law enforcement agencies.

2. If you threaten to cause severe harm to yourself, I am permitted to reveal information to others if I believe it is necessary to prevent the threatened harm.

3. If you reveal or I have reasonable suspicion that any child, elderly person, or incompetent person is being abused or neglected, the law requires that I report this to the appropriate county agency.

4. If a court of law orders me to release information, I am required to provide that specific information to the court.

5. If you have been referred to me by a court of law for therapy or testing, the results of the treatment or tests ordered may have to be revealed to the court.

6. If you are or become involved in any kind of lawsuit or administrative procedure (such as worker’s compensation), where the issue of your mental health is involved, you may not be able to keep your records or therapy private in court.

7. If you see me in couples, group, or family therapy, I ask that each member of the therapy promise to keep whatever happens in treatment confidential. However, I cannot guarantee that others will keep this agreement.

8. In order to provide you the best treatment I can, there will be times when I may seek consultation from another licensed mental health professional. In these consultations, I make every effort to avoid revealing your identity. The consultant is also legally bound to keep the information confidential, although the exceptions to confidentiality apply to them as well.

Please also honour my right to privacy, self-care and boundaries.

If you are having sessions online, please dress as if you were in my office, and sit at a desk, so I can clearly see you from your chest upwards.

If you are a business owner, and want to clear the barriers to your success and step into your future you, you need to do my coaching option. I do NOT work on that in the same way or level in my therapy practice.

Please make sure all your details are completed above. Click the tick box next to confirm that you agree, and then click on "book your session", if it hangs, you probably missed a step...