Register

Registration is only required if you do not have a username. Please check your spam & junk mail folders to ensure you have not already received an email with a username and password. If you already have a username log in here

Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

Patient Information

/ Middle Initial

( optional )
 

( MM-DD-YYYY )








( for Text Message Reminders )

Bill To Contact


/ Middle Initial







Emergency Contact

First Name
Last Name
Phone
Mobile
Relation
Email

Log in Details

( If patient is a minor, the legal guardian must enter their email address below. )



Between 8 and 40 letters and numbers

Challenge Questions

( These will be used to retrieve your password. Answers must be between 4 and 30 characters, cannot contain any spaces. )




( If you feel you must write down your questions in order to remember them, make sure to keep it in a safe place. )

Terms and Policy

Consent

By participating in this guided journaling service you understand and agree to the following:

Consent:

You provide consent for treatment within this journaling portal via written communication with your therapist, including assessments and referrals for other treatment as needed.

Membership:

Responsibility for non-refundable payment for guided journaling services of $49 per week, charged monthly and the authorization to bill your method of payment. Your guided journaling membership is month-to-month and automatically renews unless and until you cancel your membership, or it is terminated by your therapist. 

Cancellation:

You may cancel your membership at any time. Upon cancellation, your billing subscription will be suspended, and you will retain access to your account through the end of your monthly billing period. No refunds or credits will be provided for any partial-month membership periods. To cancel your account, please send a message through this secure portal or email Shermin@SherminDavis.com. 

Privacy Practices/Confidentiality:

You have read the notice of privacy practices below and understand that if you have any questions regarding this notice or your privacy rights, you may contact Shermin Davis, LMHC at Shermin@SherminDavis.com:

The law protects the relationship between a client and a psychotherapist and information cannot be disclosed without your written permission.

Exceptions include:

Suspected child abuse or dependent adult or elder abuse are required by law to be reported to the appropriate authorities immediately. 

If threatening serious bodily harm to another person/s, police must be notified and the intended victim must be informed. 

If an intention to harm yourself becomes evident to your therapist, every effort will be made to enlist your cooperation in ensuring your safety. If you do not cooperate, further measures will be taken without your permission as required by law in order to ensure your safety.

Emergency/Crisis:

If you are experiencing an emergency or crisis, do not use this service. Instead call 911 in the US or the emergency number in your country (http://bit.ly/crisislines) right away. You can also go to www.crisistextline.org or text HOME to 741741 from anywhere in the US, anytime, about any type of crisis or go to the following link for more help anywhere in the world: https://www.befrienders.org/

( Type Full Name )