U.CLIENT PARTICIPATION CONTRACT TEMPLATE

CLIENT PARTICIPATION CONTRACT

Rights of the Client:

1.The Client has the right to receive health care in a safe and secure environment.

2.The Client has the right to select the healing path of their choice, be it Traditional Healing or Western Medicine.

3.The Client has the right to expect the healing services provided to be the highest standards possible using either Traditional Healing or Western Medicine.

4.The Client has the right to expect confidentiality be maintained during and after his\her wellness plan by all parties.

I, hereby enter into a voluntary agreement with

(Name of your agency and/or your treatment group) to allow their staff to provide me with a specialized treatment/sessions for my behavior(s). I understand and agree to the following conditions regarding my treatment:

  1. What I say and hear in my sessions remains confidential. This will ensure that everyone will consider this place safe for sharing their feelings and thoughts that otherwise may remain a secret.
  1. I must be punctual for meetings/appointments and stay for the entire session. By showing up on time and staying until the end of the session.
  1. I will show that I am serious about my wellness, and have respect for my peers in the group sessions.
  1. This is my wellness plan, I must try to get involved, and do not expect that my counsellor will do all the work. Initially, my counsellor will show some leadership to help facilitate and/or teach their clients how to help each other, and later, I am expected to be involved as much as possible. My personal experiences and feelings are extremely valuable and may even help someone else in the session or my questions may be helpful for others to hear. In my sessions, everybody is equal, and will get time to share.
  1. I will sit in a circle so as to be able to see everyone's faces. I must always try to look at the person that I am talking to. I will speak up so that everyone can hear me clearly.
  1. I agree to try to support others and to give positive encouragement. I understand that support is to call each group member by their first name, and to practice saying positive things about other people.
  1. I must try not to answer for another session member. It is important that we show respect for each other by allowing each one of us to do our own work.
  1. I must take self-responsibility by paying attention. I must not start other conversations to interrupt or side-track my session work.
  1. I must try my very best never to ask a question that will provide for a yes or no type of answer. By doing so, you may be making it easy for the person to deny or avoid the difficult question by plainly saying either a yes or a no. As we all know, denial is the first and most powerful weapon to avoid self-responsibility.
  1. I must always confront my thinking and feeling errors. By confronting these errors, I am ensuring that I don’t hold them inside and avoid taking self-responsibility.
  1. I must tell it like it is. It is expected that I am serious about my own wellness and that this means you are ready to behave most honestly amongst us.
  1. I must try to keep things simple so that everybody can understand me. Clear communication is needed to try to address my opinions so that every session member is able to understand my message.
  1. I must try to keep an open mind and not take offense at what people say. Keep in mind that this session is here to help you, and that sometimes in the process, some of the things said may be somewhat hurtful; no pain, no gain.
  1. No matter how hurt I am by what others say, I must at all time refrain from physical aggression. Instead, I will learn ways of dealing with facial and verbal cues to escape or avoid a potentially aggressive situation.
  1. Homework. I owe it to myself and the session to carry out the homework as agreed.
  1. I agree that I will not put myself in a position that will undermine the goals of my treatment by not have in my possession or view any substance material that I use.

I also agree to the following special conditions at the suggestion of myself or counsellor:

a)

b)

I have read this contract. I understand its contents and agree to abide by this content.

Client:Date:

Counsellor:Date:

Program Manager:Date: