Client Contract.
Therapy involves effort and requires commitment of time, money and energy. I am committed to doing all I can to make each session worth the sacrifice, but change is ultimately up to you. It will require work both in and out of our sessions. Our first few sessions will involve psycho/social assessment; after which I will share my first impression and together we will come up with a treatment plan. Sessions are 50 minutes long.
I am currently in network with Medicare, Humana, BC/BS, Healthnet and LifeSynch insurance companies. Other insurance companies can reimburse you for my services out of network. Because I have chosen to keep my practice a small one-I am not able to process billing. I found that too much of my time was spent on billing- which left less time for my clients. Therefore if you choose to use my services the full session fee is to be paid by check or cash at the time of service. I will provide you with a reciept/bill that you will then submit to your insurance for reimbursement. I am happy to provide any needed info to your insurance company.
If you fail to give 24 hours notice of a cancellation- the full amount is due.
If your account has not been paid for more than 60 days and you have not made arrangements for payment -I may use legal means to secure payment. This could involve collection agencies or court, and all legal costs will be included in the claim.
What you share in our sessions is confidential. I can only release information about our work with your written consent. There are a few exceptions. In some child custody hearings or court proceedings I can be ordered to testify. I am also legally obligated to take action to protect people from harm. If I believe that you are at risk for inflicting serious bodily harm to yourself or to another or if I believe that a child is being abused -I must contact appropriate state agencies. This could include contacting the police, seeking hospitalization for a client, or contacting people who can provide protection. I will make every effort to discuss it with you, before taking action.
If you are under 18 years of age-the law may provide your parents the right to examine your records. Otherwise I will provide parents with general information about our work together. This is unless I feel you are at risk for seriously harming yourself or someone else.
By signing below, you indicate that you have read this document and agree to abide by its terms.
Signature__________________________________________ Date ________________
