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Therapy Agreement

A Therapy Agreement must be completed prior to commencement of therapy and there is
a 14 days ‘cooling off’ period during which you may cancel your Agreement, commencing
with the date of your signature.

Download the Therapy Agreement via the button below and save it.
Open and extract the document and complete the information required on Page 1 and
Page 8.
Save the Agreement and return it to me by email.

You can also print out the document, complete it by hand and post it back to me at :
Orwellness of Rathgar,
10a Orwell Road,
Rathgar,
Dublin D06 N526

If you need further clarification, simply drop me an email and I will respond to your query.

Thank you

Download BWRT Consent Form

Book a Consultation Now

Initial Consultation

30 minutes

€0

Payment

First Session

90 minutes

€97

Payment

Subsequent Session

60 minutes

€87

Payment

EAPH Supervision

60 minutes

€57

Payment

Group/Workshop

60 minutes

€47

Payment

I am committed to helping you to help yourself and giving you the best possible treatment I can. However, I cannot guarantee you will achieve your desired outcome – you are the only one who can guarantee your success through commitment and perseverance to achieve your goal. Please note that the services I provide are not covered under current Health Insurance policies or eligible under 'Qualifying expenses' with the Revenue Commissioners who state:

"To qualify for relief your health care must be carried out or advised by a registered practitioner. A practitioner must be on either:

  • the register established under section 43 of the Medical Practitioners Act 2007
  • the register established under section 26 of the Dentists' Act 1985.

Please download, review, sign and email Therapy Agreement to carmel@carmelsemple.com before your first session.

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Carmel Semple
Orwellness of Rathgar
10a Orwell Road
Rathgar
Dublin D06 N526
 

Tel: (+353) 86 344 6673
E: carmel@carmelsemple.com

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