Client informed consent information

Agreed upon Fee for Services:
$120 per / $140 per couple session (60 minute session)
(Private health insurance rebates may be available for members of BUPA, Medibank and LaTrobe)

Payment Policy
As of 1st January 2020, the policy at Souljourn Psychotherapy is:

Advance Payment for your first session via bank account:
Westpac Bank
Naomi Sirio
BSB: 032 564
ACC: 276981

Cancellation Policy
Standard 24-hour 100% cancellation fee.

This means that, if you cancel your session within 24 hours of your scheduled confirmed appointment time, you will be charged the full fee.

Your signature here implies that you have been informed of payment and cancellation policy and are ready to commence therapy with me, Naomi Sirio (of Souljourn Psychotherapy & Training).