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My Completed Session
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Therapist name:
Alex Lozanov.
Doctor Gautier.
Doctor Molina Martin.
Elisa Crespo.
Joana Tomas.
Joseph Maussen.
Laura López.
Laura Vanderputten.
Client, First and Last name:
Type of Client:
Private Client.
Contract: MH.
Contract: University Student.
Type of payment used by my client:
REVOLUT | Counselling Madrid.
Bank transfer | Counselling Madrid.
PayPal | Counselling Madrid.
Bizum | Joseph Maussen.
Not applicable | MH contract.
Not applicable | University contract.
Date of session:
Session started at:
Type of session:
In-person.
Online.
Session nr:
1
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This session qualifies as a session to be invoiced:
Yes, session completed.
Yes, late cancellation.
Yes, no cancellation. Client did not show up.
No, client cancelled on time. Client did prepay. This will cover next session.
No, client cancelled on time. Client did not prepay.
No, client cancelled on time. No follow-up session expected: refund needed.
No, I was unable to see client at short notice. Session prepaid. Session will be re-scheduled.
No, I was unable to see client at short notice. Session not prepaid. Session will be re-scheduled.
I am confident in my ability to support this client:
1. Strongly Disagree - Referral required
2. Disagree - Referral required
3. Neutral - Will discuss in Supervision and decide afterwards
4. Agree - Will continue to work with client
5. Strongly Agree - Will continue to work with client
6. Not Applicable - (1st) session did not take place (yet)
7. This was my last session with client - No referral required
My Client is at risk of Self-harm or Harm to others
No.
Yes, Self-harm and a Safety Plan has been signed.
Yes, Self harm but no Safety Plan has been signed yet.
Yes, Harm to others and a Safety Plan has been signed.
Yes, Harm to others but no Safety Plan has been signed yet.
Is the date of your follow-up session known already?
Yes.
No, not yet.
No, this was my client´s last session.
Date follow-up session - if applicable:
Time follow-up session - if applicable:
Type of follow-up session:
In-person.
Online.
n.a.
Does this follow-up session cover more than 1 hour for you? (if applicable):
Yes, 75 minutes.
Yes, 2 hours.
Yes, 3 hours.
Yes, 4 hours.
If more than 1 hour, please indicate total cost to client for your hours:
If you don´t know the date of the follow-up session yet, please fill in this form once you know the date:
www.counsellingmadrid.org/my-followup-session
For all Private clients, please confirm their fee for follow-up sessions:
Not applicable: MH or Student client
In-person - Individual - Standard fee: €80.
In-person - Individual - Reduced fee A1: €75. (net earnings < €2.500 p.m.).
In-person - Individual - Reduced fee A2: €70. (net earnings < €2.000 p.m.).
In-person - Individual - CBT: €75.
Online - Individuals - Standard fee: €80.
Online - Individuals - Reduced fee B1: €75 - net earnings <€2.500 p.m.
Online - Individuals - Reduced fee B2: €75 - net earnings <€2.000 p.m.
Online - Individual - CBT: €75.
In-person - Child Psychology - Standard fee: €90.
In-person - Couples - Standard fee: €90.
In-person - Couples - Standard fee - 90 min: €160.
Online - Child Psychology - Standard fee: €90.
Online - Couples - Standard fee: €90.
Online - Couples - Standard fee - 90 min: €160.
Online - Systemic Family Therapy - Standard fee: €90.
In-person - Systemic Family Therapy - Standard fee: €90.
In-person & Online - Life Coaching - Individuals - Standard fee: €80.
In-person & Online - Life Coaching - Couples - Standard fee: €90.
Trauma Therapy - PTSD - Standard: €90.
Medical Doctor - Diagnostic Assessment (ADHD, ASD etc.): €135.
Medical Doctor - Medication PRESCRIPTION (first time medication prescription): €135.
Medical Doctor - Prescription REFILL / Change in existing Prescription: €130.
Other: please describe below, under Observation.
Observation (optional):
Thank you for submitting confirmation of your session.
Kind regards,
Joseph
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