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Flora Therapy Form

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Welcome to Flora Essentials, LLC!

It is my honor to have you here.

I am a Licensed Clinical Social Worker who provides intuitive, evidenced-based therapeutic interventions both virtually and in-person.

I blend a variety of holistic remedies to provide luminescent treatment with love and empathy.

As a natural lightworker, please view our time together as a conduit towards your healing.

Please fill out the form below to schedule an appointment. I will follow up with an email.

I look forward to sharing time with you!

-Sarah Goff, LCSW

*Flora Essentials, LLC only accepts private pay, HSA, and FSA. Prices will be discussed prior to the intake appointment.

Communication Policy: Because of the nature of this specific structure, Sarah Goff, LCSW will only be able to schedule emergency appointments and/or be available to handle emergency situations with current patients. If you or someone you know is in need of emergent services, please call 911 or go to your nearest hospital. For business purposes, Sarah Goff, LCSW will only communicate via email at floraessentials542@gmail.com. Sarah Goff, LCSW is practicing out of Indiana. If you are a virtual appointment, please understand time zone differences. Please allow up to 48 hours for an emailed response.

*please electronically sign below with your name and date.

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1.) Your treatment is confidential! No one may have access to your records or the information shared in your appointments without your specific permission or the permission of a legal guardian (e.g. written ‘Release of Information’).

The noted exceptions to this rule are as follows:

a. Provider believes the client to be a danger to themself or others.
b. Provider believes a child or elderly adult is being abused or neglected.
c. Parents or legal guardians of non-emancipated minor client have the right to access client records as requested.
d. Records are required by court subpoena.

In the event of any of these exceptions, the provider has a moral, legal, and ethical duty to break the client’s confidentiality in order to intervene appropriately.

I agree to the above limits of confidentiality and understand their meanings and ramifications.

*please sign electronically below with your name and date.

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Financial Responsibility: I accept full financial responsibility for any and all charges for therapeutic services provided. Payment must be made within 24 hours of receiving your invoice. Flora Essentials, LLC only accepts private pay. Prices will be discuss prior to the initial intake appointment.

*please sign your name below with the date

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Cancellation and Payment Policy: Please email floraessentials542@gmail.com to cancel your appointment. Cancellations or changes must be made 48+ hours in advance of the appointment.

Patients may reschedule their appointments 48+ hours in advance at no extra charge. Appointments will be cancelled at full charge if the patient does not check into the zoom call within 15 minutes after the beginning of your scheduled appointment time.

Repeating appointments may be scheduled. This service is provided as a courtesy. Any repeated cancellations or missed appointments may result in the cancellation of subsequent appointments. If a patient no-calls, no-shows their appointment, a refund will not be issued. Payment for all sessions will be due before services are provided. This policy is not meant to be punitive, but meant to provide the most quality care through accountability and with respect to the provider, as well as to the needs of all clients scheduling. By signing this policy, you are agreeing to the above conditions.

Cancellations 48+ hours = no fee.
Cancellations 25-48 hours before service = $75.
Same day cancellations = full fee.
No-call/no-show = full fee

*please sign electronically with your name and date.

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Discharge Policy: To make the best possible use of therapy it is important that you attend regularly scheduled appointments, and take an active role in your care. In order to maintain a good balance of care, if you do not participate in therapy for 90 days, your file will be considered closed. Similarly, if you miss 2 or more appointments in a row, your file may be closed. You are free to contact the provider and return to therapy at any point, at the discretion of the provider. By signing this policy, you are agreeing to the above conditions.

*please sign electronically with your name and date.

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Please provide your name, address, date of birth, email, and phone number.

Sarah Goff, LCSW will send an email within 48 hours to schedule an appointment. After scheduling an appointment, and invoice will be sent to secure the session. Payment must be made within 24 hours of the sent invoice.

Your information will be used to create your profile for scheduling and invoice services. Looking forward to your energy!

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