Discharge Notice Form (Page 2 of 2) in pdf

Discharge Notice Form Page 2

Noeticus Counseling Center and Training Institute

™

Innovative Approaches to Counseling and Change

I understand that I may seek a second opinion from another therapist or may terminate

therapy at any time. If I do decide to terminate therapy, I agree to inform my therapist as

far in advance as possible, or if this is not possible, at the beginning of the last session at

which I am to meet. In a therapeutic relationship of any length, termination and closure

are very important processes and most people find their experience to be incomplete if

there has not been an adequate opportunity to discuss the reasons for ending. Advance

notice also allows both me and my therapist to pace the therapeutic process

appropriately.

Finally, we want to hear from you about how we're doing! That's why we've created an

anonymous Client Satisfaction Survey. If you haven’t done so already, please take a few

minutes to visit the website below and let us know what worked for you and what didn’t. Thanks

in advance for sharing your thoughts, ideas, suggestions, and frustrations with us – your

feedback makes our services more effective and helpful. Here’s the link:

- Anonymous Client Satisfaction Survey -

We thank you for allowing us to provide psychotherapeutic and counseling services to you and

sincerely invite you to contact us again now or in the future should you need or desire further

services. Thank you.

Therapist Name: ________________________________________________________________

Therapist Signature: _____________________________ Date: _________________________

NOTE: _______________________________________________________________________

______________________________________________________________________________

Last Printed 2/28/2012

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Discharge Notice Form Page 2