• Agreement To Receive Services

  • I understand and agree to be treated by a therapist who is an Associate and is not an employee of Dunham Counseling Center, Ltd. but is an independent contractor renting space and services from Dunham Counseling Center, Ltd.

    I understand and accept that Dunham Counseling Center, Ltd. handles all administrative and billing work for the Associate, including but not limited to submitting bills to my medical insurance coverage agency or organization. I understand and accept that the bills will be submitted in the name of Dunham Counseling Center, Ltd. with the Associate identified on all claims as the individual provider, and that the Associate will receive all monies for any services rendered to me.

    I understand and agree that Dunham Counseling Center, Ltd. is not responsible for any treatment and my clinical records. I understand and agree that the Associate is solely responsible for my treatment and clinical records.

    I understand and agree that in the event the Associate is unable or refuses to continue providing services to me, that the Associate is responsible for referrals for continuing treatment. Dunham Counseling Center, Ltd. may but is not required to assist me in finding an alternative professional to continue my treatment. I have entered my signature below to show that I understand all these  statements of the duties and limitations of Dunham Counseling Center, Ltd.

    Your therapist has a late cancellation policy of 24 hours notice.  If you do not show or cancel within 24 hours you will be charged. Cancellation fees vary by therapist. Please discuss the cancellation fee amount with your therapist.

    The typed name acknowledges your consent to this Agreement to Receive Services at Dunham Counseling Center, LTD.

  • Date Format: MM slash DD slash YYYY
Individual Therapy & Counseling
  • Individual Counseling
  • Psychotherapy
  • Cognitive Behavioral Therapy
  • EMDR
  • Emotional Freedom Techniques
  • Holistic Health
  • Life Coaching
  • Men's and Women's Issues
  • Single Life Problems
  • Mid Life and Mid Career Dilemmas
  • Stress Management and Relaxation
  • Depression, Anxiety, Anger and Loss
  • Coping with Medical Illness
  • Christian Counseling
  • Financial Issues
  • Addiction
  • Co-dependency
  • Adult Survivors of Sexual Abuse
Couples & Marriage Counseling
  • Affairs
  • Anger in Relationships
  • Alcohol and Drugs Issues
  • Communication Difficulties
  • Intimacy Issues
  • Divorce Counseling
  • Parenting Differences
  • Relationship Satisfaction
  • Trust Issues
  • Financial Issues
Adolescent & Young Adults Counseling
  • Anger Issues
  • Life Change Adjustment
  • Alcohol and Substance Abuse
  • Divorce Adjustment
  • Self Esteem
  • Behavioral Problems
  • Peer Relationships
  • Parenting Issues
Family Therapy
  • Adoption & Fertility Counseling
  • Blended Families
  • Kids, Divorce and Recovery
  • Parenting Issues
  • Relationship Issues
Alcohol, Drugs & Addictions
  • Alcohol Abuse & Addiction Counseling
  • Drug Abuse & Addiction Counseling
  • Gambling Addictions
  • Workplace Alcohol & Substance Abuse Issues
  • Compulsive Spending
  • Process Addictions
  • Marriage and Family Counseling for Addictions
  • Neuro Feedback Treatment for Cravings
Workplace Counseling and Coaching
  • Family Business Issues
  • Executive Counseling & Coaching
  • Career Direction & Development
  • Conflict Management Skills
  • Issues of Mid Career and Retirement Planning
  • Issues of Personal Stress, Confidence and Satisfaction
  • Anger Management
  • Stress
  • Anxiety Issues
  • EAP programs
Family Business Coaching
  • Ownership Transitions
  • Family Relationships
  • Family Conflict
  • Family Governance
  • Parent/Child Relationships in Business
  • Generational Issues
  • Roles & Responsibilities
  • Succession Planning
Faith Based Counseling
  • Christian Counselors