Life-Skill Intensives Service Agreement

I agree to the following:

1. I understand that Life-Skill Intensives are educational in nature. While Dawn Huebner is a licensed psychologist in New Hampshire, I understand that she will not be providing therapy. Therapy aims to diagnose and treat mental health problems, while Life-Skill Intensives are designed to teach my child and me techniques to better manage a specific problem area.
2. I understand that once my child and I sign up for a Life-Skill Intensive, we cannot become therapy clients. If, over the course of our Life-Skill Intensive, Dawn and/or I believe that therapy is warranted, we will talk about that, and Dawn will do her best to guide me towards appropriate resources although it will ultimately be up to me to find a suitable therapist.
3. I understand that if my child enters therapy, or is already in therapy, it is my responsibility to inform our therapist of the Life-Skill Intensive, and to make sure he/she agrees with our participation. I will download and have the therapist sign the Therapist Awareness form available on Dawn’s website and will return it to Dawn in a timely manner.
4. I understand that while Dawn will teach skills, make suggestions and offer advice during the Life Skill Intensive, I, the client, assume full responsibility for deciding which actions to take. I will not hold Dawn legally responsible for any undesired outcomes.
5. I understand that if it becomes clear that the Life-Skill Intensive is not the right vehicle for our child, I will talk to Dawn about that. If we have paid in advance, we will only be charged for the time we have used (at the full rate described below).
6. I understand that each Life-Skill Intensive is composed of five 50-minute modules. The first and last module are for parent(s) alone, while the middle three are for parent(s) and child together.
7. I understand that I cannot submit claims to my insurance company for reimbursement, as this is not therapy.
8. I understand that I am responsible for the time we have scheduled, and that I must give at least 24 business hours’ notice to cancel or reschedule a module unless something happens that is completely outside my control. The payment (if made ahead) for a module cancelled with at least 24 business hours’ notice will be credited toward the new meeting time.
9. I understand that Dawn’s policy is to keep Life-Skill Intensives records private. However, because this is not therapy, records for Life-Skill Intensives are not privileged.
10. I understand that payment can be made by cash or check (made out to Dawn Huebner), and that fees are as follows:

Download the Life-Skill Intensives Service Agreement.
Please complete the form and bring it to your first meeting.