PSYCHOTHERAPY INTAKE & CONSENT | 2026
Please fill in your details below, noting the required fields.
Feel free to contact me directly if you have any questions or require further clarification.
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 danger
2. a child (or vulnerable adult) is endangered, abused, or neglected
3. or the prenatal use of dangerous controlled substances is reported.
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 kept to the sessions themselves.
Payments are to be made directly by the patient to myself.
Reimbursements are to be resolved between the patient and the insurer, and medical aids when providing 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. Please contact your provider directly if unsure.
While coverage may apply for certain conditions, such as the Prescribed Minimum Benefit (PMB) in South Africa for Major Depressive or Bipolar Disorder, I can only assist with activation when this is reflective of the actual medical 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.
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.
I send invoices at month's end. Please settle the account within the first 7 days of the new month.
The initial session is charged as per a normal session.
From there we will discuss and confirm the billing policy. Typically, psychotherapy is charged for a particular session time, usually weekly. This session time is exclusively reserved for the patient, for the agreed upon duration with prearranged breaks.
As such, arranged sessions are always charged in full regardless of attendance. This includes late arrivals, no shows, and cancellations. The reason for this is that while I can fill the space at short notice, I cannot ethically take on another patient unless I can commit to continuing to seeing them weekly.
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 bulling aside from the 72 hour notice.
By signing below, I acknowledge that I have read and understood this intake and consent document.
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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.
