K. PHILIPPE GENDRAULT, Ph.D.

Clinical Psychologist, PSY 19040

3702 Sacramento Street San Francisco, CA 94118 Tel.: 415-289-7033 Consent to Treatment
About psychotherapy: Psychotherapy is often helpful as a means of relieving distress, understand ones person motivations, and improving the quality of ones life. It requires a joint effort, and a significant commitment from you in terms of effort, time, and money. It is a process that varies depending on the personality of the therapist and the patient, as well as motivation, effort, life circumstances, and the nature and severity of the problems to be addressed. While therapy is designed to be helpful, it may at times be difficult and uncomfortable. Confidentiality: Everything you discuss with me is confidential and I can only release information about our work together with written consent. There are certain circumstances, however, that under law require or permit me to disclose information: 1) When there is reasonable suspicion of child abuse or neglect, or evidence of elder abuse. 2) When a person presents an imminent and/or potentially serious danger to self or others 3) In the even of certain court order to subpoena information or records Payment for Services: We will determine a fee together during our initial consultation. This fee will be reevaluated yearly. Payment is due at the time of service. Please notify me if any problem arises during the treatment regarding your ability to make timely payments. Cancellations: One we decide on a regular time or times to meet during the week you are responsible for paying for that time. If you need to reschedule an appointment I will do my best to accommodate you. If we are able to reschedule within a reasonably short time (1 to 2 weeks) you will not be charged for the cancelled sessions, otherwise you will be charged. You also will not be charged when the therapist is away from the office. Your participation in therapy is voluntary and you may discontinue at any time. In the best of circumstances we would decide together when to end treatment. In the event that you wish to end treatment, I would strongly encourage you to discuss this desire with me. Since uncomfortable feelings that arise in therapy often contribute to a desire to quit, it is important to fully explore these feelings to determine the best course of action (i.e., continued therapy, discontinue, seek other treatments). Emergencies: If you nee to contact me, you can call me at 415-289-7033 and leave a message at any time. I check my messages daily and will call you back as soon as possible. If you have an emergency and cannot reach me immediately, you may call 911 or SFGH Psychiatric Emergency Services at 415-206-8125.

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