Under The Willow Tree Gippsland
Counselling, Equine Assisted Psychotherapy and Life Coaching
PO BOX 144
TOONGABBIE, VIC 3856
PH: 0478 674 143
underthewillowtreegippsland@outlook.com
www.underthewillowtreegippsland.com.au
ABN: 79 457 187 141
Equine Assisted Therapy Service Agreement
This Agreement is made between:
Client Name: ___________________________ Counsellor Name: ___________________
Date: _________________________________
1. Purpose of Agreement
This agreement sets forth the terms and conditions under which Caitlin Crichton, ACA Level 2, a registered and qualified Counsellor and owner of Under The Willow Tree Gippsland, will provide Equine Assisted Therapy services to [Name]. The goal of these services is to promote emotional healing, personal growth, and overall well-being through therapeutic interactions with horses.
2. Confidentiality
All information discussed during therapy sessions is confidential. The therapist will not disclose any information shared during the sessions without the client’s consent, except in the following circumstances:
• If the therapist believes there is a risk of harm to the client or others.
• If required by law (e.g., child or elder abuse reporting).
• If mandated by court order.
3. Equine Assisted Therapy Sessions
• Length of Sessions: Sessions will last approximately 60 minutes, then notes 15minutes.
• Frequency of Sessions: Sessions will be scheduled weekly, fortnightly, monthly or as agreed.
• Location of Sessions: Sessions will take place at 65 Thompson Drive Cowwarr.
• Therapeutic Approach: The therapy will involve interactions with horses, including activities such as grooming, leading, and observation. The specific activities will depend on the client's goals and comfort level.
4. Fees and Payment
• Rate: The fee for each session is $195.20 (+GST for Private Paying)
• Payment: Payments are due at the time of service unless otherwise arranged. Payment can be made via Direct Deposit, EFTPOS, or cash.
• New Private (NON-NDIS) Clients: 1st session payment must be paid 24 hours before the scheduled session to the account below.
Account Name: Under the Willow Tree Gippsland
BSB: 633 000
ACC NO: 215 677 634
5. Cancellation Policy
If you need to cancel or reschedule a session, please give notice 24 Hours before the scheduled Session. Cancellations with less than 24 Hours’ notice will incur a fee of 100% cost of the session. If there are any extenuating circumstances, please contact me to discuss. Ex: Repeated cancellations may result in termination of services.
6. Client’s Responsibilities
As the client, you agree to:
• Arrive on time for your scheduled sessions.
• Actively participate in the therapy process, including working with the horses.
• Notify the therapist of any concerns, physical or emotional discomfort, or special needs before or during a session.
• Understand that participation in Equine Assisted Therapy may involve physical activity, and you will follow all safety instructions provided by the therapist.
7. Horse Safety and Liability
The Equine Assisted Therapy approach involves interacting with live animals. While every precaution will be taken to ensure a safe experience, you understand and acknowledge that:
• Horses are large animals, and there is an inherent risk of injury or harm during equine activities.
• You are responsible for following all safety instructions and guidelines provided by the therapist and the facility.
• The therapist and facility will take reasonable steps to minimise risks, but you are participating at your own risk.
• You are encouraged to wear appropriate footwear and clothing suitable for working around horses.
8. Emergency Procedures
In case of emergency, the therapist will follow the facility’s emergency procedures. If you feel unwell or need assistance, please inform the therapist immediately. The therapist will ensure you receive appropriate attention.
9. Termination of Services
Either party may terminate the therapy relationship at any time. If you decide to discontinue therapy, it is recommended that a final session be scheduled to review your progress and discuss any ongoing support needs. If the therapist believes the services are not in your best interest, they may refer you to another professional or terminate the therapy relationship.
10. Informed Consent
By signing this agreement, you acknowledge that you have been fully informed of the nature of Equine Assisted Therapy delivered by our ACA Level 2 Registered and Qualified Counsellor, Caitlin Crichton, including its risks and benefits. You understand and consent to participate in the therapy sessions under the terms outlined above.
________________________________________
Client Signature
By signing below, you agree to the terms and conditions outlined in this agreement:
Signature: _______________________________
Date: ___________________________________
Counsellor Signature
Signature: _______________________________
Date: ___________________________________
Under The Willow Tree Gippsland
Counselling, Equine Assisted Psychotherapy and Life Coaching
PO BOX 144
TOONGABBIE, VIC 3856
PH: 0478 674 143
underthewillowtreegippsland@outlook.com
www.underthewillowtreegippsland.com.au
ABN: 79 457 187 141
Counselling Service Agreement
This Agreement is made between:
Client Name: ___________________________
Therapist Name: _________________________
Date: _________________________________
1. Purpose of Agreement
This agreement sets forth the terms and conditions under which Caitlin Crichton ACA Level 2, registered and qualified counsellor and Owner of Under The Willow Tree Gippsland will provide counselling services to [Name] The goal of these services is to provide a supportive, confidential environment for personal development and emotional well-being.
2. Confidentiality
Counselling sessions are confidential, and any information shared will not be disclosed to others without your written consent, except in the following circumstances:
• If there is a risk of harm to yourself or others.
• If there is a legal obligation (e.g., court order).
• If there is a disclosure of child or elder abuse or neglect. Records of sessions will be kept securely and in accordance with relevant privacy laws and ethical guidelines.
3. Counselling Sessions
• Length of Sessions: Each session will last approximately [60 minutes].
• Frequency of Sessions: Sessions will take place weekly, fortnightly, monthly or as agreed upon.
• Location: Sessions will be held at [65 Thompson Drive Cowwarr or Online/Telephone]. If online, the platform will be [Zoom].
• Payment and Fees: The fee for each session is $156.16. (+GST for Private Paying) Payment is due at the time of the session unless otherwise agreed upon. Payments can be made via Bank Transfer. EFTPOS, or cash.
• New Private (NON-NDIS) Clients: 1st session payment must be paid 24 hours before the scheduled session to the account below.
Account Name: Under the Willow Tree Gippsland
BSB: 633 000
ACC NO: 215 677 634
4. Cancellation Policy
If you need to cancel or reschedule a session, please give notice 24 Hours before the scheduled Session. Cancellations with less than 24 Hours’ notice will incur a fee of 100% cost of the session. If there are any extenuating circumstances, please contact me to discuss. Ex: Repeated cancellations may result in termination of services.
5. Your Role in the Counselling Process
As a client, your active participation is essential for the success of therapy. You agree to:
• Attend sessions regularly.
• Be open and honest in sharing your thoughts and feelings.
• Actively engage in the therapeutic process.
6. Termination of Services
Both you and your therapist have the right to terminate the counselling relationship at any time. If you decide to end therapy, it is encouraged to have a final session to review progress and discuss any future support needs. If the therapist believes they are not able to meet your needs, they will provide referrals to other professionals.
7. Emergency Situations
In case of an emergency or if you require immediate assistance, please contact “000”.The therapist does not provide emergency crisis support services outside of scheduled sessions.
8. Informed Consent
By signing this agreement, you acknowledge that you have read and understood the terms and conditions outlined above. You consent to receiving counselling services under these terms.
9. Fees and Payment
• Rate: $156.16 per session.
• Payment Due: Payment is due at the time of each session unless otherwise agreed.
• Cancellation Policy: Please refer to section 4 for information on cancellations.
________________________________________
Client Signature
By signing below, you agree to the terms and conditions outlined in this agreement:
Signature: _______________________________
Date: ___________________________________
Therapist Signature
Signature: _______________________________
Date: ___________________________________