Informed Consent Form
Please Read Carefully:
(1) I am at least eighteen years of age, and voluntarily seek philosophical counseling from David Kaye, Ph.D. I am free to seek his services
on a continuous or intermittent basis, or to discontinue them at any time.
(2) My identity as a client will remain confidential with regard to any research publications and/or oral presentations of the contents of our
(3) If the issues we discuss include particular up-coming choices, the counselor will neither determine what I should or should not do, nor
make any choices for me. Rather, the counselor will help me to clarify the implications of my possible choices.
(4) The following benefits are expected to result from the counseling process:
(i) Minimally, I should gain a deeper understanding of the issues we discuss.
(ii) Maximally, I should be more empowered to cope with or to resolve said issues.
(5) No risks are expected to result from the counseling process.
(6) The client’s right to privacy will be safeguarded, and, as a result, all information obtained from our sessions will be regarded as strictly
confidential unless disclosure is required by law in order to prevent imminent, substantial harm to the client or others. In such highly
exceptional cases the appropriate authorities will be notified.
(7) If the counselor adjudges that my issues are not primarily of philosophical concern, or that they should not be addressed in the first
place through philosophical counseling, then the counselor will refer me for alternative professional consultation. Philosophical counseling
is for educational purposes only, and is not designed to treat any psychological or somatic illness.
(8) The fee for the initial consultation and subsequent sessions is $250 (USD), and must be tendered at least 24 hours prior to the
commencement of every session.
I understand that
i) Cancelation of appointments made between 72 and 24 hours before the appointment start time will be billed for one half of the
scheduled session; cancelations made less than 24 hours before the appointment will be billed for the full scheduled session.
ii) Payment must be received at least 24 hours in advance of every session. If payment is not received at least 24
hours in advance of a session, the session will be cancelled. If the counselor is forced to cancel three sessions due to such
instances of non-payment, the counselor-client relationship will be terminated.
I have read, understood, and hereby consent to each of the above. I have had an opportunity to ask preliminary questions about
philosophical counseling in general and about David Kaye’s philosophical practice in particular. All questions that I asked were answered
to my satisfaction.