Susan Gorey

Psychotherapy and Conflict Resolution

Agreement to Mediate

Please review this Agreement to Mediate before committing to either a mediation or an initial consultation to mediate. It serves as our contract with each other and with the other party or parties to the mediation.

I will go over the Agreement with all parties before we begin the initial mediation session, and the mediator and all parties will sign the original document together at that time.

For now, if you wish to schedule a mediation session, please copy, complete, scan or send by regular mail the final page of this form authorizing me to charge your credit card for your share of my fees. If you prefer to provide me with your credit card number by an alternative method for security purposes (or a combination of methods—telephone, email, text, and/or regular mail,) please feel free to do that.

Psychotherapy Client Consent

Please review this Psychotherapy Policies, Practices, and Client Consent form before we meet for our initial session. It serves as our contract with each other. I will be happy to answer any questions when we meet.

To save time during our initial session, please copy, complete, scan, send by regular mail, or bring with you the final page of this form authorizing me to charge your credit card for any unpaid balance due.

Parent Coordination Agreement

Please review this Psychotherapy Policies, Practices, and Client Consent form before we meet for our initial session. It serves as our contract with each other. I will be happy to answer any questions when we meet.

To save time during our initial session, please copy, complete, scan, send by regular mail, or bring with you the final page of this form authorizing me to charge your credit card for any unpaid balance due.