As a client of Choosing Change Counseling, you may be discharged for one or more of the following reasons:

• Client has successfully completed their treatment goals.
• Client requires a different level or type of care.
• Client has not attended therapy within the past 6 months.

*Note if the client desires to come back to therapy after being discharged for one of the above circumstances, they are able to contact Choosing Change Counseling to reopen their file after completing required paperwork.

• Client has been harassing the staff or disruptive to the treatment of other
• Therapist is managing life-changing circumstances (i.e.- death, illness, relocation, retirement, etc.)
• Client is unable to pay for session. If so, Choosing Change will administratively discharge client and refer them to a lower fee provider.

My signature below represents that I understand and accept the above.