1258 High Street, Eugene, OR 97401

Phone 541-342-8437 | Fax 541-242-2999

SOAR Treatment Agreement

Name:   Date of birth:

I understand and agree to the following treatment conditions:

• On-time attendance is required for all individual and group therapy sessions, unless prior permission to be late or miss a session is given by treatment or legal supervising officer (PO), or in the case of emergency or illness. Documentation of emergency or medical appointment to treat illness may be required for tardiness or absence to be excused.
• Participation in both individual and group therapy is a requirement.
• Respectful and safe communication and behavior in all interactions with agency staff, therapists, and other SOAR participants must always be maintained; failure to do so may result in probationary status or immediate termination from the program.
• Substance use, including but not limited to tobacco, is prohibited before and during individual and group therapy and anywhere on CFD premises.
• Cell phones and other personal electronic devices are to be put on silent or airplane mode and stored away during individual and group therapy sessions.
• Confidentiality must always be maintained. This includes the identities of all past and current SOAR participants and group members, any other individuals discussed during participation in the SOAR program, and all content and written work discussed in group.
• Honesty is a key part of success in this treatment program and is required.
• I am responsible for all treatment costs not covered by a third-party payer, including any monthly and testing fees. I understand that account balances over 60 days past due will result in termination from the program. If I am utilizing the monthly fee arrangement, I am responsible for paying the full monthly fee, regardless of the number of services I attended in that month. All balances due will need to be paid in full before I can graduate from the program.
• The SOAR program may require polygraph exams for treatment planning and assessing compliance with treatment conditions. Polygraph exams may include a full sexual history, two or more maintenance polygraphs per year, and if needed, a specific incident exam. Polygraph reports are shared with my PO.
• Arousal assessments may be part of treatment when indicated.
• Timely completion of all treatment projects and supplemental assignments determined by my individual and group therapist as necessary is required.

Confidentiality

Confidentiality of all SOAR program participants must always be maintained. This includes all content and written work discussed in therapy by current or past SOAR participants.

I understand that the identities of all current and past SOAR participants are to be kept confidential. I understand confidential to mean that I will not disclose to anyone outside of the group I attend any information which could, in any way, be used to identify another SOAR participant or a current or former SOAR group member. I agree to hold all such information as confidential. I also agree to hold confidential the identities and persons named or discussed in group.

SOAR Material Agreement

I understand I am required to bring my SOAR treatment materials to every group and individual session. If I lose, destroy, or do not have access to my treatment materials, I will ask for a replacement. If I lose, destroy, or do not have access to other treatment materials that were purchased and provided to me (folders, etc.) I agree to pay the current replacement cost needed for repurchasing that material.

Failure to participate with honesty, projects, supplemental assignments, and polygraphs in a timely manner, to comply with treatment or legal conditions, to demonstrate reasonable and consistent progress, or to maintain confidentiality may result in immediate termination from the program.

By signing below, I acknowledge that I have read and understand this form, have had the opportunity to ask questions, and agree to the language in this agreement.