PSYCHOTHERAPY INTAKE & CONSENT | 2026
Please fill in your contact details below, as well as the section on the terms of service.
What is your reason for seeking psychotherapy?
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Limits of Confidentiality
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While all of our sessions and communications are confidential, certain limits do apply.
I am legally required to take appropriate steps, including contacting emergency services, healthcare providers, designated emergency contacts, or relevant authorities where:
1. your life, or the life of another person, is indicated to be in imminent danger
2. a child (or vulnerable adult) is endangered, abused, or neglected
3. or the prenatal use of dangerous controlled substances is reported.
Outside of these very specific conditions, in which I will still communicate directly with yourself and seek to clarify and resolve prior, confidentiality is taken exceptionally seriously and no requests from other parties, including close family members, as to session content is ever entertained.
Communications | Privacy
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Medical records and clinical notes are stored within protected systems to maintain privacy and conform to the Protection of Personal Information (POPI) act. I use two factor authentication, password protected folders, locked cabinets etc.
However, I cannot guarantee the security of systems beyond my control. Please limit all out of session communications to practical purposes only: arrangements, requests, etc. All personal and sensitive information is to be kept to the sessions themselves.
Payments are to be made directly by the person responsible to my account.
Any medical aid reimbursements are to be resolved between the patient and the insurer, and medical aids when will reimburse the member directly.
Please be aware that medical aid benefits generally do not cover unspecified psychotherapy, and provisions are plan and diagnosis dependent.
While coverage may apply for certain conditions (such as the Prescribed Minimum Benefit (PMB) in South Africa for some depressive and mood disorders) I can only assist with activation when this is reflective of the actual psychiatric condition.
Similarly, I provide invoices with an ICD-10 Diagnostic code for insurance purposes and reimbursements, but this is always purely reflective of actual diagnosis and treatment.
Sessions are 50 minutes in length.
The 2026 local session rate is R1550.
The 2026 international session rate is £90.
There is an annual increase, effective from the first of January of each year which will be communicated in advance.
Invoices are sent at months' end with EFT details.
If paying in cash is preferred, please make use of an envelope.
Payment is to be completed within 10 days of receipt of the account. After 30 days, the account will accrue interest, and sessions will need to be suspended.
The initial session is charged as per a normal session.
Psychotherapy is charged for a particular fixed session time, at minimum once weekly, sometimes more.
This arranged time is exclusively reserved for the patient, either indefinitely as we continue, or for an agreed and prearranged duration.
These arranged sessions are always billed in full regardless of attendance. This includes late arrivals, no shows, and cancellations. This is structurally important for therapeutic work.
In general, public and school holidays are excluded and we will discuss dates prior in order to accommodate for any travel or other plans.
In concluding treatment, at least 72 hours notice (excluding weekends / public holidays) is required or the final session will be charged in full. However, you may terminate treatment at any time with no consequence to further billing aside from this 72 hour notice period.
By signing below, I acknowledge that I have read and understood this intake and consent document, and agree to the terms and conditions of service.
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I consent voluntarily to receive psychological assessment and/or psychotherapy services from Sean Friedman (HPCSA PS0159018 | PCNS 1168010 | HCPC PYL046126).
I understand the nature of these services, the limits of confidentiality, the fee structure, and the billing policy. I understand that I may discontinue treatment at any time, subject to the terms outlined above.
