Counselling Madrid | Doctor Moser | My Completed Session

Client: First & Last name:

Type of client:

Type of payment used by my client:

Date of session:

Session started at:

Type of session:

Session nr:

This session qualifies as a session to be invoiced:

OPTIONAL: I am confident in my ability to support this client:

OPTIONAL: This client and I are working on mutually agreed upon goals:

OPTIONAL: This Client is at risk of Self-harm or Harm to others:

Is the date of your follow-up session known already?

Date follow-up session - if applicable:

Time follow-up session - if applicable:

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Does this follow-up session cover more than 1 session (50 min.) for you? (if applicable):

If more than 1 session, please indicate total cost to client for your time:

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 & insurance clients, the fee for follow-up session:

Observation (optional):

Doctor Moser: My completed session