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Policy Statement for Individual Work - Effective 2010 November 1, 2010 With the level of work we are doing, weekly appointments are seldom necessary. We will meet in person, by telephone, or Skype. After each session I request that you make a very brief written statement of your immediate insights from our shared encounter. There are several assessment devices I like to use that give the two of us a significant head start in understanding how well your personality is supporting your greatest human potential. You may select use of one or all of these, but please choose at least one. assessment fee ___ Professional Executive Assessment $300 ___ Brief Professional Assessment 100 ___ A Measure of your Character Strengths 80 ___ Periodic Measure of Self-kindness 0 Please return a signed copy of this letter and one half of your assessment fee or a deposit of $100 (whichever is larger) and we will schedule your first appointment. Your deposit and future session fees will be fully reimbursed if cancellations are made at least 24 hours before the scheduled appointment time. Late cancellationss are a loss for me in both time and money. You can make payments via PayPal or credit card at http://www.consciousdynamics.com/payment.html and email this form to mary@citta101.com or write a check or money order drawn on a US bank and mail it and the form to the address below. I look forward to getting to know you! Mary Mary Rees 713-662-2743 mary@citta101.com www.citta101.com I understand that my payments cannot be considered a charitable donation and that Mary is a meditation teacher and spiritual director, not a therapist. My process leads the work, so I am free to accept or reject any suggestions. Mary adheres to ethical guidelines of both the Spiritual Directors International and the Safe Harbor guidelines for Insight Meditation Teachers. Upon request, she will send me a pamphlet on ethics in Spiritual Direction and/or tell me how to order Safe Harbor, ethics for meditation teachers. __________________________________ __________________________________ signature date PDF format available at http//www.citta101.com/ProAgreement.pdf |