Six-Session Service Contract

    Simcha Shtull agrees to provide premarital / early-stage counseling sessions to the undersigned couple. Compensation paid to Simcha by the couple will be $535 for six 50-minute sessions, payable at the first session and non-refundable, or $100 per session, paid weekly.

    For the 6-session prepaid package, efforts will be made by both Simcha and the couple to schedule the sessions over the course of 6 consecutive weeks, at the same hour.

    • At least 24 hoursʼ notice is required for cancellation, if the session is not to be forfeited.
    • All pre-paid sessions in each engagement must be scheduled within a 3‐month time frame.
    • Please refer to Counselorʼs Disclosure Statement for Confidentiality Statement.

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    Therapist
    Simcha Shtull, MA, LMHCA
    347-866-0515
    [email protected]


    Client Signature
    Client (1) name:

    Client (1) email:

    Client (2) name:

    Client (2) email:

    Date:

    By clicking the "Yes" box, we attest that we have read, understood and accepted the terms in this Service Contract.