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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.

Billing/Cancelation policies:

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.

Informed Consent Form: Text
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