Please review carefully

    Agreement for Services for:

    Scheduling and Fees

    The fee for services is a consultation benefit to you provided by your company addressing communication strategies and healthy relationships, not therapy treatment. When you make an appointment, that time is reserved for you. Please give 24 hours notice if you need to change/cancel your appointment. Failure to abide by the 24 hour cancellation policy may result in the loss of benefit.

    Do you agree? YesNo

    WIT Limitations of Confidentiality

    Issues discussed are important and are generally legally protected as both confidential and “privileged.” However, there are limits to the privilege of confidentiality. These situations include:

    • Suspected abuse or neglect of a child, elderly person or a disabled person.
    • If you WIT Professional believes you are in danger of harming yourself or another person or are unable to care for yourself.
    • If you report that you intend to physically injure someone, the law requires your WIT Professional to inform that person as well as the legal authorities.
    • If your WIT Professional is ordered by a court to release information as part of a legal involvement in company litigation, etc.
    • In natural disasters whereby protected records may become exposed.
    • When otherwise required by law.


    Do you agree? YesNo

    Additional Limits of Confidentiality Relating to Electronic Communications

    • While using every reasonable means to protect and encrypt conversations and records of care, when communicating with WIT Professionals by Internet or other electronic means, such encryption cannot be guaranteed.
    • By agreeing to engage in services by Internet or other electronic means, the WIT Professional and Employee will each assure that any text messages or recorded discussions will be destroyed within fifteen days of receipt.
    • You, the Employee, are encouraged to protect your own confidentiality by controlling access to your communications such as using passwords only known by you, controlling access to your computer, deleting data as agreed, etc.
    • When communicating by internet or other electronic means, disruptions in service or other technical difficulties may occur from time to time. It is understood that should a disruption occur at a time of a crisis; the Employee agrees to immediately phone their WIT Professional.
    • It is understood that sometimes the written word can be misunderstood. If a WIT Professional and Employee are communicating with text and questions arise about the meaning of a statement, the Employee is asked to bring his or her questions to the WIT Professional’s attention as soon as possible so that misunderstandings may be explained and any ensuing problems be averted or avoided.


    Do you agree? YesNo

    Dispute Resolution

    Any unresolved dispute arising from WIT services is to be resolved by binding arbitration.

    Other Resources

    WIT Professionals may suggest Employee avails themselves to outside supportive resources, including, but not limited to, other health care professionals.

    Professional Conduct and Ethics of WIT Owner

    WIT Professionals Owner agrees to abide by the Ethical Standards of the Washington and California Association of Marriage and Family Therapists. These standards are accessible on the Association's websites www.camft.org and www.wamft.org. She also complies with the standards of professional conduct in the licensing law for the profession of marriage and family therapists (California Business and Professions Code 4982, which can be accessed at the Board of Behavioral Sciences' website www.bbs.ca.gov).

    Do you agree? YesNo

    Employee Honesty

    It is understood that, should it be discovered that, at any time during the course of consultations, the Employee has misrepresented their identity to WIT, the WIT Professionals benefit will be terminated immediately.

    Integrated Care and Release of Information

    Due to the nature of working with an interdisciplinary team, I hereby authorize the release and exchange of all pertinent medical, psychological, and educational information concerning myself to the professionals identified in our company's membership agreement for use in support through WIT.

    This authorization shall be valid as long as the Client above is receiving services from WIT Professionals. I know that I have a right to a copy of this authorization and that a photocopy of this authorization shall be valid as the original.
    I have read and understood the above information. I accept and agree to abide by the contents and terms of these agreements and further, consent to participate in WIT benefits. I understand that I may withdraw from support at any time. I am aware of my rights and responsibilities as a Employee and have reviewed the HIPAA Privacy Consent Document on the WIT Website.

    Liability Disclaimer

    I understand that all consultation is done on my behalf in confidentiality with WIT Professionals. I also understand WIT limits of confidentiality. I agree not to file a civil lawsuit or claim for compensation against WIT Professionals or the company providing the benefit of this consultation.

    Do you agree? YesNo

    GENERAL INQUIRIES

    • 925.785.0558

    • witprofessionals@gmail.com

    • 12826 SE 40th Lane, Suite 203
      Bellevue, WA 98006

    TEAM

    Praise for Wit

    Last year I made a serious effort to improve employee retention because it is key to my business success.  My employees are my best asset and I wanted to improve loyalty and morale.  I hired Tori and her team of WIT professionals as a “wellness” benefit for my employees and I have been astounded at how much it has helped.  I thought I was hiring Tori to help my employees, but as the business owner, Tori provides me a level of support that is unmatched by any HR professional or counselor.  She is my first call when I need advice and wise counsel regarding all of my business relationships.

    Kathy Franklin, Owner, European Wax Center - Castro Valley, CA

    As a trusted licensed marriage and family therapist for 25+ years, Tori has journeyed relationship challenges with executives, non-profit and church leaders, their families and friends.  Her expertise provides a focused approach that efficiently penetrates the mind and holds the heart. Her compassion for each situation is palatable. Her devotion to each company is impressive. The results are effective.

    Tom Dowd - Owner, Dowd and Guild - San Ramon, CA
    Kristi Rinehart

    Tori has a knack for bringing clarity to core issues in communication and relationships in tension and then providing concrete steps forward. Her professional coaching has been instrumental in helping me navigate delicate client negotiations with integrity. I highly recommend her as a go-to advisor and coach on all things relational.

    Kristi Rinehart - Principal, Rinehart Marketing - Coeur d'Alene, ID

    WIT Professionals is an amazing team of professionals that helps your business improve the culture, productivity, and well-being of your workforce. Tori helps engage healthy strategies with the burdensome challenges we all face in work and life relationships. Tori is truly gifted at assisting leaders and employees with understanding their own internal and relational barriers. I cannot speak highly enough of Tori Dabasinskas.

    Jeff Hunt, Founder & CEO, GOALSpan - San Francisco, CA

    Our company has used Tori to assist with communication, provide clarity and new perspectives to our employees through group training sessions on Stress Management.  She has also been instrumental in supporting our management team.  Tori is an active listener, who asks deepening questions throughout the process.  This approach allows both parties a deeper understanding of the issue and helps the individual reach a solution with greater confidence.  By doing so, we are more comfortable dealing with difficult situations. 

    Tina Onderbeke - Executive VP & Partner, Dowd and Guild - San Ramon, CA

    Tori has a relational style that instantly creates an atmosphere of openness and mutual respect.  She has a keen ability to empower, affirm and show compassion to everyone.  She sees all sides to an issue and helps resolve communication challenges swiftly.  Her sense of humor and overflowing joy always lifts our spirits and her wisdom and giftedness has saved me hours and hours of stress. 

    Kathy Franklin, Owner, European Wax Center - Castro Valley, CA

    Rather than letting frustrations build and damage workplace relationships, Tori has helped us meet communication challenges by diffusing them through understanding.  Tori is a true professional who is able to put people immediately at ease and engage in meaningful conversation, which ultimately leads to better decision making and solutions.

    Tina Onderbeke - Executive VP & Partner, Dowd and Guild - San Ramon, CA
    Valley Dental Group - Dr. Kane, Dr. Chan, Dr. St. Marie

    We really loved having Tori and Mary-Beth speak to our company. It was one of the most professional and personally beneficial staff meetings we have had to date. We loved having their perspective on personalities and inter office relationships and really striving to know ourselves better so that we can interact better as a team. They are a wonderful asset to our company!

    Dr. Kane, Dr. Chan and Dr. St. Marie, Valley Dental Group - Renton, WA