Online Agreement
IMPORTANT! (MUST READ)- You must be in the state of California at the time of counselor/client interaction to participate in this site's online therapy.
- You must be over the age of 18.
- If you are in crisis and need immediate help, please call the crisis hotlines listed on this web page. Online therapy is not for those who suffer from serious mental disturbances, suicidal or homicidal thoughts, or other mental/emotional issues that might require intervention by local law enforcement or psychiatric hospitalization.
- Everything you share with me is completely confidential EXCEPT if I am made aware of any child and/or elder abuse cases (physical, sexual, emotional), there is a suicide plan, a detailed plan to hurt or kill somebody or plans for major destruction of property.
As a client of Lily Kotila, at sandiegotherapy.org, I agree to the above conditions. I understand that there is a possibility that there may be technical problems with the Internet that are not the fault of Lily Kotila. The Internet may be affected by: server issues, viruses, software or hardware problems or natural and/or man-made problems. These issues and problems are not the fault of Lily Kotila. If there were an Internet problem, email may be delayed. If there were a problem and we had an instant message session set up, it would be rescheduled. Lily Kotila's response to me will be within 48 hours. If I do not receive a response in 48 hours (which would be due to one of the above examples), it is my responsibility to send my message again.
The email is intended only for the designated recipient(s). If you are not a designated receiver of this information, please notify sender immediately and delete this message. It is extremely important that you double check your email address so that the response goes to the correct person. It is not the responsibility of Lily Kotila if this message is sent to the wrong person due to an incorrect email address submission.
I acknowledge that Lily Kotila is an MFT intern under the supervision of Laura Carr MFT#38400 and they practice in the state of California. Lily Kotila and Laura Carr are subject only to the laws and regulations of the state of California. I realize that I will be charged $40.00 US Dollars for each email submitted and/or 30-45 minutes of online chat. (If you are utilizing the chat room, Chatzy utilizes Secure Sockets Layer (SSL) protocol which automatically encrypts in transit the text we exchange from the chat room to our computers. SSL protocol is the widely used standard for sending credit card information when making online purchases, thus my private chat room is highly secure. No one can intercept or eavesdrop on our conversations, no one monitors the chat room, and no one keeps a record of our conversations other than you or I. If for some reason, somebody does break through this secure access, it is not the fault of Lily Kotila. She will not be held liable).
I recognize that during as part of the therapeutic process, psychological discomfort may arise as difficult issues are addressed and worked through. This part of therapy is often necessary in the growth process, although by no means does it guarantee my desired outcome. Lily Kotila is not responsible if the client is not satisfied with the response or the outcome of the therapeutic interaction between the client and Lily Kotila. I can end the services at any time without any reason and without prior notification or explanation to Lily Kotila at sandiegotherapy.org. I also acknowledge that, while Lily Kotila MFT intern has taken a significant number of steps to ensure the confidentiality of online communication, these actions, in whole or in part, cannot guarantee the security of Internet transmissions. It is not the responsibility of Lily Kotila if you choose to have someone or people in the room with you while you are using email therapy or chat therapy and they have issues or disagreements with the thoughts and statements of the counselor. The outcome of my relationships as a result of online or chat therapy is a result of my actions. I permanently agree to release and indemnify Lily Kotila from all suits, claims, and other actions originating from psychotherapy provided to me by Lily Kotila.
The information that I am filling out in the therapeutic questionnaire is for professional purposes only. Responding to questions is voluntary but it is highly recommended. Confidentiality of all submitted information will be strictly maintained and the details you supply will not be released to anyone unless mandated by law or your written request and signed consent. While all questions are optional, please understand that the more information you provide Lily Kotila, the more she will be able to help you.
The trust between a counselor and a client is very important. It might feel risky to share personal information, but a counselor does not judge behavior, nor does she tell you how to live your life. It is the counselor's job to help the client grow in the areas where s/he desires and it is hard to do that without thorough information. The more questions the client answers, the better and more productive will be the responses of the counselor. Maximize your investment of your time and money and be as comprehensive as possible. By submitting this form to Lily Kotila along with the questions, I, the client, am agreeing to this contract.
Please enter your name and date in the form below and click "Submit".
Enter date as mm/dd/yyyy example - 07/15/2006
San Diego Therapy
Lily Kotila
Email: Email Lily
Phone 619 218-5363
Address: 1419 University Ave.
Suite C