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Building on strengths to empower lives.

NEW CLIENT INFORMATION:
Confidentiality

Because trust is critical in the therapeutic process, matters discussed during the course of therapy are held in confidence and not shared with anyone without your written permission. The few exceptions to this rule are as follows: professional reporting is required if there is suspicion of child abuse or reason to believe a client may present imminent threat of harm to another individual. Second, a court of law may require the release of records. Third, you may authorize me in writing to share information for a specific purpose such as insurance coverage. Outside of these exceptions, your privacy is protected and patient rights granted by the 2003 Federal Health Insurance Portability and Accountability Act (HIPAA).

In the treatment of minors, it is my policy to request that parents respect the confidentiality between the child and myself. Therefore, I suggest parents refrain from questioning their child regarding the specifics discussed during sessions. I do encourage children to share important information and feelings with their parents. If circumstances arise I consider important for parents to be informed about, I will arrange a meeting for the child and parents to discuss the relevant issues. In addition, as one of the goals of family therapy is to encourage appropriate and open communication among family members, our efforts in therapy will be directed toward this end. In such situations, I will be available to answer questions and make suggestions to parents regarding their relationship with their children and other specific situations that may arise during treatment.

If another professional is involved in the care and treatment of you or your family members, particularly a mental health professional, I will request that a release be signed so that we may communicate to coordinate efforts. It is also helpful in planning our work together for me to obtain information from any previous counseling relationship or results of a psychological evaluation and your written consent will be requested for such. These policies are all intended to increase the efficiency of our time working together by minimizing wasted time and effort.


Fees

Payment in full is expected at the time of service unless other arrangements have been made. If I am an in-network provider with your health insurance plan, your co- payment is expected at the time of service. Should your insurance plan decline payment for any reason, responsibility for full payment of the fee rests with the client. If you maintain other health insurance, part of your expenses may be covered. I will prepare a monthly statement reflecting services provided, fees paid and other information your insurance company needs to reimburse you directly. Other services outside of scheduled appointments such as report writing, extended telephone conversations, consultation with other professionals with your permission, preparation of records or treatment summaries, etc will be based on this hourly rate.

 

Click Here to View Brief Patient Health Questionnaire

Click Here to View Self Monitoring form

Click Here to View Our Privacy Policy

Click Here to View Our Client Services Agreement

Click Here to View PSYCHOLOGICAL HISTORY

Click Here to View Our Parent Consent Form

Click Here to View Confidentiality Contract

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