Confidentiality: Your information is confidential and protected. I will not release any information about your therapy unless you authorize me to do so in writing. This includes speaking with your legal representation or family members. However, the following exceptions are required by law:
Suspected child abuse or dependent adult or elder abuse, for which I am required by law to report this to the appropriate authorities immediately.
If a client is threatening serious bodily harm to another person/s, I must notify the police and inform the intended victim.
If a client intends to harm him/herself, I will make every effort to work with them on ensuring their safety. If they do not cooperate, I will take further measures without their permission that are provided to me by law in order to ensure their safety.
Fees and Cancellations: Fees are set and agreed upon in advance of all sessions. Full payment is due at the end of each session, unless otherwise arranged and agreed upon. I request 24 hours’ notice for cancellations. Otherwise, you will be financially responsible for the full cost of the session for the time reserved for you. Brief phone calls are also available to support therapy. If you require extended phone consultations, those sessions will be billed at my regular rate.
Contact Information: You may call, text or email for scheduling and other items that need brief discussion. I check messages several times a day and usually call or write back within 24 hours, if not before. If you have a life-threatening emergency you will need to call 9-1-1. In such an incident, please contact me as well and I will follow up on your treatment. If I am on vacation or out of the office for any reason, I will inform you with advanced notice and determine a contingency/coverage plan.
Insurance Reimbursement: I am an ‘Out of Network’ provider and you may be able to get reimbursed for our sessions. When requested, I can provide you an invoice with a diagnosis and you may submit this form and be reimbursed partially or fully for therapy sessions depending on your specific policy. Patients are responsible for finding out the specifics of their insurance coverage and reimbursement options. This form may help.