Provisions regarding the treatment agreement

 

 

 

 

– The therapist is required to act in accordance with legal regulations. The rights and obligations of the client and care provider are laid down in, among other things, the Medical Treatment Agreement Act (WGBO) and the Quality, Complaints and Disputes Care Act (Wkkgz).

– The therapist who works with children under the age of 16 concludes a written treatment agreement with both parents, provided that they both have parental authority.

– The therapist keeps a client file. The client has the right to inspect his own file. The file is stored for a total of 15 years in accordance with the legal retention period.

– The therapist undertakes to provide information regarding the treatment to the client at all stages of the treatment. The client undertakes to provide the therapist with relevant information through the intake interview.

– The therapist maintains confidentiality with regard to the information provided by the client. However, with the exception of the data on which the client has stated that he / she does not object to the use for statistical purposes.

– The therapist may not perform certain treatments without the client’s consent.

– The therapist undertakes to refer the client correctly to a colleague therapist or a doctor if her / his treatment is inappropriate and / or adequate.

– The treatment can be terminated at any time by mutual consent.
If the person requesting assistance no longer appreciates the continuation of the agreement or considers it necessary, he / she may terminate it unilaterally. If the person requesting the therapist terminates the agreement against the therapist’s advice, the person requesting the therapist will sign a statement stating that he has prematurely terminated the research or treatment against the therapist’s advice in the investigation or treatment.
The therapist can only unilaterally terminate the agreement stating arguments if it cannot reasonably be expected of him / her to continue the agreement. The therapist will continue to provide help and advice in such a situation, until the person asking for help can conclude an agreement with another care provider.

– The client agrees with the rate of € 85 per consultation.

– Payment method for the treatments is per pin / on account / cash per consultation.

– The client undertakes to cancel an appointment in time (at least 24 hours in advance), otherwise the costs of the reserved time may be charged.

– For complaints about the treatment, the client can turn to the secretariat of the Association for Iokai Shiatsu Therapists (www.iokai-shiatsu.org). The client then has the choice of whether he / she has the complaint within the V.I.S. wants to discuss with a confidential counselor, or wants to turn to a complaints officer of SCAG, a national dispute settlement body for complementary and alternative care. If a complaint cannot be handled as desired, the complaint will be submitted to the SCAG disputes committee. For disciplinary law, the client can turn to the TCZ Foundation, Disciplinary Complementary Care (www.tcz.nu).

– All possible adverse consequences arising from the withholding of information present in the medical file at the GP are for the account and responsibility of the client.
Treatment agreement

The undersigned,

…… InnerChoice-Shiatsu, Christophe Dumont, Hoge Zand 3A, 2512EK The Hague …………………………………………………………………………………………

and (name of parent (s))

…………………………………………………… residing in …………………………………… .. (parent)

…………………………………………………… residing in ……………………………………… (parent)

hereby declare that they have agreed to shiatsu therapy.

The treatment agreement is signed by the therapist and both parents, if they both have parental authority, and entails rights and obligations for all parties to which they can be called.

With the signing of this agreement, the undersigned declare that they have taken note of and agree with the provisions under which the treatment will take place.

Signature:

Place and date………………………………………………………………………………………

Therapist: Client:

………………………………………… …………………………………………………

Parent / caregiver 1, Parent / caregiver 2,
………………………………………… ………………………………………………… ..

Child data:

Name: ……………………………………………… boy / girl
Address: …………………………………………………………………………….
Zipcode and city: ………………………………………………
Date of birth: ………………………………………………