Common use of Appointment Scheduling and Cancellation Policies Clause in Contracts

Appointment Scheduling and Cancellation Policies. Sessions are typically scheduled to occur one time per week at the same time and day if possible. Your therapist may suggest a different amount of therapy depending on the nature and severity of your concerns. Your consistent attendance greatly contributes to a successful outcome. In order to cancel or reschedule an appointment, you are expected to notify your therapist at least 24 hrs. in advance of your appointment. If you do not provide your therapist with at least 24 hours notice in advance, you are responsible for payment for the missed session. Please understand that your insurance company will not pay for missed or cancelled sessions. Telephone consultations between office visits are welcome. However, your therapist will attempt to keep those contacts brief due to our belief that important issues are better addressed within regularly scheduled sessions. You may leave a message for your therapist at any time on his/her confidential voicemail. If you wish your therapist to return your call, please be sure to leave your name and phone number(s), along with a brief message concerning the nature of your call. Non-urgent phone calls are returned during normal workdays (Monday through Friday) within 24 hours. If you have an urgent need to speak with your therapist, please indicate that fact in your message and follow any instructions that are provided by your therapist’s voicemail. In the event of a Your therapist may need to communicate with you by telephone, mail, or other means. Please indicate your preference by checking one of the choices listed below. Please be sure to inform your therapist if you do not wish to be contacted at a particular time or place, or by a particular means. My therapist may send a fax to me. My fax number is: ( ) _ It is your therapist’s intention to provide services that will assist you in reaching your goals. Based upon the information that you provide to your therapist and the specifics of your situation, your therapist will provide recommendations to you regarding your treatment. We believe that therapists and clients are partners in the therapeutic process. You have the right to agree or disagree with your therapist’s recommendations. Your therapist will also periodically provide feedback to you regarding your progress and will invite your participation in the discussion. Due to the varying nature and severity of problems and the individuality of each patient, your therapist is unable to predict the length of your therapy or to guarantee a specific outcome or result.

Appointment Scheduling and Cancellation Policies. Sessions are typically scheduled to occur one time per a week at the same time and day if as much as possible. Your You and your therapist may suggest a different amount of therapy depending on the nature and severity of your concernscan discuss if more or less frequent sessions are appropriate. Your consistent attendance greatly contributes to a successful outcome. In order to cancel or reschedule an appointment, you are expected to notify your therapist at least 24 hrs. hours in advance of your appointment. If you do not provide your therapist with at least cancelation 24 hours notice in advance, you are responsible for payment for the missed session. Please understand that note: your insurance company will not pay for missed or cancelled sessions. Telephone consultations You are welcome to contact your therapist in between office visits are welcomesessions. However, your therapist will attempt to keep those contacts brief due to as a general rule, it is our belief that important issues are better addressed within regularly scheduled sessions. You may leave a message for your therapist at any time on his/her confidential voicemail. If you wish would like your therapist to tor return your call, call please be sure to and leave your name and phone number(snumber (s), along with a brief message concerning regarding the nature of your call. Non-Non- urgent phone calls are will be returned during the therapist’s normal workdays (Monday through Friday) within 24 hoursworkday schedule, as soon as possible. If you have an feel it is urgent need to that you speak with your therapist, please indicate that fact in this information when leaving your message and follow any instructions that are provided by your therapist’s voicemail. You may be charged for the time the therapist spends communicating over the phone if the time exceeds 15 minutes. In the event of a medical or psychiatric emergency or an emergency involving a threat to your safety or the safety of others, Please be sure to leave your name and phone number(s), and a brief message regarding the nature of your call. Your therapist is typically available to return your call soon as possible during normal working days. Your therapist is not available to return calls after . Your therapist is not available to return calls on . Your therapist may need to communicate with you by telephone, mail, telephone or other means. Please indicate your preference preferences by checking one of marking the choices listed boxes below. Please be sure to inform your therapist if indicate any days/times you do not wish to be contacted at a particular time or place, or by a particular meanscontacted. My therapist may call me on my home phone. Home phone #: My therapist may call me on my cell phone. Cell phone #: My therapist may send a fax text message to my cell phone. Cell phone #: My therapist may call me at work. Work phone #: *My therapist may email me. Email address: My fax number istherapist may send mail to my home address. Home address: ( ) _ It *Disclosure statement regarding text or email communication: Sensitive clinical information is to be discussed on the phone or in person. Potential risks of using electronic communication may include, but are not limited to; inadvertent sending of an email or text containing confidential information to the wrong recipient, theft or loss of the electronic devise, and interception by an unauthorized third party through an unsecured network. E-mail messages may contain viruses or other defects and it is your therapist’s intention responsibility to provide services ensure that will assist you in reaching your goalsit is virus-free. Based upon Additionally, e-mail or text communication may become a part of the information that you provide to your therapist and the specifics of your situation, your therapist will provide recommendations to you regarding your treatment. We believe that therapists and clients are partners in the therapeutic processclinical record. You have may be charged for the right time the therapist spends reading and responding to agree e-mail or disagree with your therapist’s recommendations. Your therapist will also periodically provide feedback to you regarding your progress and will invite your participation in the discussion. Due to the varying nature and severity of problems and the individuality of each patient, your therapist is unable to predict the length of your therapy or to guarantee a specific outcome or resulttext messages.

Appointment Scheduling and Cancellation Policies. Sessions Your first session will be an Intake Session during which we can review your paperwork, discuss the reasons why you are typically scheduled seeking counseling, discuss current and background information, and talk about your goals. Additionally, I can answer any questions you might have about therapy. At this session, you will not be pressured to occur one discuss any information that you don't feel ready to disclose. At that point, you have more information to decide whether or not you wish to embark upon a course of treatment with me as your therapist, and the pace at which you desire to proceed. If we decide we might be a good fit, we will then schedule another appointment and proceed with developing a treatment plan. I will do my best to provide you with a regular appointment day and time per week at the same time if you prefer. Scheduling an appointment is a commitment that both counselors and day if possibleclients honor. Your therapist may suggest a different amount of therapy depending on the nature and severity of your concernsScheduled appointment times are reserved exclusively for you. Your consistent attendance greatly contributes to a successful outcome. In order All cancellations need to cancel or reschedule an appointment, you are expected to notify your therapist at least 24 hrs. in advance of your appointment. If you do not provide your therapist with be made at least 24 hours notice in advance. For sessions canceled with less than 24 hours notice or if a client misses a session for any reason other than emergency or illness, you are responsible for payment for the missed sessionclient will be required to pay a fee equal to the full hourly (53 minute) session rate. Please understand that your insurance company Insurance will not pay for missed appointment fees. Please be prepared to pay the full session fee from your appointment that was either missed or cancelled sessions. Telephone consultations between office visits are welcome. However, your therapist will attempt to keep those contacts brief due to our belief that important issues are better addressed within regularly scheduled sessions. You may leave a message for your therapist at any time on his/her confidential voicemail. If you wish your therapist to return your call, please be sure to leave your name and phone number(s), along with a brief message concerning the nature of your call. Non-urgent phone calls are returned during normal workdays canceled late (Monday through Friday) not within 24 hours) when you attend your next scheduled appointment. If you have an urgent need 2 cancellations or missed sessions without providing me 24 hours notice, it will be necessary to speak with your therapist, please indicate that fact in your message and follow discuss potential barriers to continued treatment as well as if services are to continue. I charge the full session fee for any instructions sessions that are provided by shortened due to your therapist’s voicemaillate arrival or early departure. I cannot accommodate making up for lost session time unless it is due to my error. For clients utilizing insurance benefits, I can bill your insurance for the actual amount of time we are in the session, not how long you have scheduled. In the event case of shortened sessions due to your late arrival or early departure from our scheduled time (not related to emergencies), I reserve the right charge you the difference of what your insurance will cover and my full rate for the hour. This charge will be to your card on file or included in a Your therapist may subsequent billing statement. If you cancel or miss an appointment with less than 24 hours notice, you will be charged the full fee of the missed appointment to either your card on file or in the next billing statement. It’s important to remember that insurance does not pay for missed appointments, so you will be responsible for the full appointment fee, not just a copay. I will notify you via phone or email if I should need to communicate with cancel our appointment, so it is very important to keep contact information up to date. You will not be charged if I cancel our appointment. If for some reason you by telephone, mailfail to pay the fee at the time of service, or other meansthe fee is owed for a missed appointment, you may be required to send payment for the amount owed before another appointment can be scheduled. Please indicate your preference by checking one If payments are not made in a timeframe we have agreed upon, then I may notify debt collectors. If it becomes necessary for the account to be referred for collection action, you agree to pay the actual balance due plus any collection expenses and any attorney’s fees. If there are extended periods of the choices listed below. Please be sure to inform your therapist if time where you do not wish initiate contact, respond to be contacted efforts to contact, or attend sessions, it may become necessary for me to end our therapeutic relationship. This typically occurs when, without coordinating with me, there's a period of no contact that exceeds 30 days. In such instances, if you find yourself in a better position at a particular later time or placeto attend sessions and want to re-engage in services, or by this will be considered after a particular means. My therapist may send a fax to me. My fax number is: ( ) _ It is conversation about your therapist’s intention to provide services needs at that will assist you in reaching your goals. Based upon the information that you provide to your therapist time and the specifics of your situation, your therapist will provide recommendations to you regarding your treatment. We believe that therapists and clients are partners in the therapeutic process. You have the right to agree or disagree with your therapist’s recommendations. Your therapist will also periodically provide feedback to you regarding your progress and will invite your participation in the discussionmy current availability. Due to the varying nature and severity of problems my work schedule and the individuality fact that I do not interrupt sessions with patients to take phone calls, I am often not immediately available by telephone. However, you are free to leave a message on my voicemail and I will make every effort to return your call as soon as possible, with the exception of each patientweekends and holidays. My current days in the office are limited to Mondays and Tuesdays. As my hours vary and are by appointment only, the time of day at which I return your therapist is call may vary. If you are difficult to reach or have restrictions on receiving phone calls, please inform me of some times when you will be available. Occasionally I will be unavailable due to trainings or vacation. If you are unable to predict reach me and feel that you cannot wait for a return call, you can contact the length of your therapy nearest emergency room, crisis service, or to guarantee a specific outcome or resultanother counselor if needed.

Appointment Scheduling and Cancellation Policies. Sessions are typically scheduled to occur one time per week at the same time and day if possible. Your therapist may suggest a different amount of therapy depending on the nature and severity of your concerns. Your consistent attendance greatly contributes to a successful outcome. In order to cancel or reschedule an appointment, you are expected to notify your therapist at least 24 hrs. hours in advance of your appointment. If you do not provide your therapist with at least 24 hours notice in advanceadvance except in case of sudden illness or family emergency, you are responsible for payment for the missed session. Please understand that your insurance company will not pay for missed or cancelled sessions. Telephone consultations between office visits are welcome. However, your therapist will attempt to keep those contacts brief due to our belief that important issues are better addressed within regularly scheduled sessions. You may leave a message for your therapist at any time on his/her confidential voicemail. If you wish your therapist to return your call, please be sure to leave your name and phone number(s), along with a brief message concerning the nature of your call. Non-urgent phone calls are returned during normal workdays (Monday through Friday) within 24 hours. If you have an urgent need to speak with your therapist, please indicate that fact in your message and follow any instructions that are provided by your therapist’s voicemail. In You should also be aware of the event of a following resources that are available in the local community to assist individuals who are in crisis: Crisis Hotline: (000) 000-0000 Youth Shelter: (000) 000-0000 Domestic Violence Help: (000) 000-0000 Hospital: (000) 000-0000 Your therapist may need to communicate with you by telephone, mail, or other means. Please indicate your preference by checking one of the choices listed below. Please be sure to inform your therapist if you do not wish to be contacted at a particular time or place, or by a particular means. My therapist may send a fax to me. My fax number is: ( ) _ It is your therapist’s intention to provide services that will assist you in reaching your goals. Based upon the information that you provide to your therapist and the specifics of your situation, your therapist will provide recommendations to you regarding your treatment. We believe that therapists and clients are partners in the therapeutic process. You have the right to agree or disagree with your therapist’s recommendations. Your therapist will also periodically provide feedback to you regarding your progress and will invite your participation in the discussion. Due to the varying nature and severity of problems and the individuality of each patientclient, your therapist is unable to predict the length of your therapy or to guarantee a specific outcome or result.

Appointment Scheduling and Cancellation Policies. Sessions Your first session will be an Intake Session during which we can review your paperwork, discuss the reasons why you are typically scheduled seeking counseling, discuss current and background information, and talk about your goals. Additionally, I can answer any questions you might have about therapy. At this session, you will not be pressured to occur one time per week discuss any information that you don't feel ready to disclose. At that point, you have more information to decide whether or not you wish to embark upon a course of treatment with me as your therapist, and the pace at the same time which you desire to proceed. If we decide we might be a good fit, we will then schedule another appointment and proceed with developing a treatment plan. I will do my best to provide you with a regular appointment day if possibleand time. Your therapist may suggest Scheduling an appointment is a different amount of therapy depending on the nature commitment that both counselors and severity of your concernsclients honor. Scheduled appointment times are reserved exclusively for you. Your consistent attendance greatly contributes to a successful outcome. In order All cancellations need to cancel or reschedule an appointment, you are expected to notify your therapist at least 24 hrs. in advance of your appointment. If you do not provide your therapist with be made at least 24 hours notice in advance. For sessions canceled with less than 24 hours notice or if a client misses a session for any reason, you are responsible the client will be required to pay a fee equal to the session rate (currently $160 for payment individual counseling, $190 for the missed sessionfamily counseling). Please understand that your insurance company Insurance will not pay for missed appointment fees. Please be prepared to pay the full fee from your appointment that was either missed or cancelled sessions. Telephone consultations between office visits are welcome. However, your therapist will attempt to keep those contacts brief due to our belief that important issues are better addressed within regularly scheduled sessions. You may leave a message for your therapist at any time on his/her confidential voicemail. If you wish your therapist to return your call, please be sure to leave your name and phone number(s), along with a brief message concerning the nature of your call. Non-urgent phone calls are returned during normal workdays canceled late (Monday through Friday) not within 24 hours) when you attend your next scheduled appointment. If you have an urgent 2 cancellations or missed sessions without providing me 24 hours notice, it will be necessary to discuss potential barriers to continued treatment as well as if services are to continue. I charge the full session fee for any sessions that are shortened due to your late arrival or early departure. I cannot accommodate making up for lost session time unless it is due to my error. I will notify you via phone and/or email if I should need to speak with your therapistcancel our appointment, please indicate that fact in your message and follow any instructions that are provided by your therapist’s voicemailso it is very important to keep contact information up to date. In You will not be charged if I cancel our appointment. If for some reason you fail to pay the event fee at the time of a Your therapist may need to communicate with you by telephone, mailservice, or other meansthe fee is owed for a missed appointment, you may be required to send payment for the amount owed before another appointment can be scheduled. Please indicate your preference by checking one If payments are not made in a timeframe we have agreed upon, then I may notify debt collectors. If it becomes necessary for the account to be referred for collection action, you agree to pay the actual balance due plus any collection expenses and any attorney’s fees. If there are extended periods of the choices listed below. Please be sure to inform your therapist if time where you do not wish initiate contact, respond to be contacted efforts to contact, or attend sessions, it may become necessary for me to end our therapeutic relationship. This typically occurs when, without coordinating with me, there's a period of no contact that exceeds 30 days. In such instances, if you find yourself in a better position at a particular later time or placeto attend sessions and want to re-engage in services, or by this will be considered after a particular means. My therapist may send a fax to me. My fax number is: ( ) _ It is conversation about your therapist’s intention to provide services needs at that will assist you in reaching your goals. Based upon the information that you provide to your therapist and the specifics of your situation, your therapist will provide recommendations to you regarding your treatment. We believe that therapists and clients are partners in the therapeutic process. You have the right to agree or disagree with your therapist’s recommendations. Your therapist will also periodically provide feedback to you regarding your progress and will invite your participation in the discussiontime. Due to the varying nature and severity of problems my work schedule and the individuality fact that I do not interrupt sessions with clients to take phone calls, I am often not immediately available by telephone. However, you are free to leave a message on my voicemail and I will make every effort to return your call on the same day you make it, with the exception of each patientweekends and holidays. As my hours vary and are by appointment only, the time of day at which I return your therapist is call may vary. If you are difficult to reach or have restrictions on receiving phone calls, please inform me of some times when you will be available. Occasionally I will be unavailable due to trainings or vacation. If you are unable to predict reach me and feel that you cannot wait for a return call, you can contact the length of your therapy nearest emergency room, crisis service, or to guarantee a specific outcome or resultanother counselor if needed.

Appointment Scheduling and Cancellation Policies. Sessions are typically scheduled to occur one time per week at the same time and day if possible. Your therapist may suggest a different amount of therapy depending on the nature and severity of your concerns. Your consistent attendance greatly contributes to a successful outcome. In order to cancel or reschedule an appointment, you are expected to notify your therapist at least 24 hrs. in advance of your appointment. If you do not provide your therapist with at least 24 hours notice in advance, you are responsible for payment for the missed session. Please understand that your insurance company will not pay for missed or cancelled sessions. Telephone consultations between office visits are welcomemay be necessary at times. However, your therapist will attempt to keep those contacts brief due to our belief that important issues are better addressed within regularly scheduled sessions. As previously stated, any telephone contact over 10 minutes in duration will be charged to you at the same rate as the session fees. You may leave a message for your therapist at any time on his/her confidential voicemail. If you wish your Your therapist will make every effort to return your call, please be sure to leave your name and phone number(scalls within 24 hours (or by the next business day), along with a brief message concerning the nature of your callbut cannot guarantee that calls will be returned immediately. NonYour therapist is unable to provide 24-urgent phone calls are returned during normal workdays (Monday through Friday) within 24 hours. If you have an urgent need to speak with your therapist, please indicate that fact in your message and follow any instructions that are provided by your therapist’s voicemailhour crisis service. In the event of a Your therapist may need to communicate with that you by telephone, mailare feeling unsafe, or other meansyou require immediate medical or psychological assistance, you should call 911 or go to the nearest emergency room. Please indicate your preference by checking one of the choices listed below. Please be sure to inform your therapist if you do not wish to be contacted at a particular time or place, or by a particular means. My therapist may send a fax to me. My fax number is: ( ) _ It is your therapist’s intention to provide services that will assist you in reaching your goals. Based upon the information that you provide to your therapist and the specifics of your situation, your therapist will provide recommendations to you regarding your treatment. We believe that therapists and clients patients are partners in the therapeutic process. You have the right to agree or disagree with your therapist’s recommendations. Your therapist will also periodically provide feedback to you regarding your progress progress, and will invite your participation in the discussion. Due to the varying nature and severity of problems and the individuality of each patient, your therapist is unable to predict the length of your therapy or to guarantee a specific outcome or result. Your therapist will not voluntarily participate in any litigation or custody dispute in which you and another individual, or entity, are parties. Your therapist has a policy of not communicating with your attorney, and will generally not write or sign letters, reports, declarations, or affidavits to be used in your legal matters. Your therapist will not provide records or testimony unless compelled to do so. If your therapist is subpoenaed, or ordered by a court of law, to appear as a witness in an action involving you, you agree to reimburse your therapist for time spent for preparation, travel, or making a court appearance at the same rate as the session fees.

Appointment Scheduling and Cancellation Policies. Sessions are typically scheduled to occur one time per week week, at the same time and day if possible. Your therapist I may suggest a different amount of therapy depending on the nature and severity of your concerns. Your consistent attendance greatly contributes to a successful outcome. In order to cancel or reschedule an appointment, you are expected to notify your therapist me at least 24 hrs. hours in advance of your appointment. If you do not provide your therapist me with at least 24 hours notice in advance, you are responsible for payment for the missed session. Please *If using a superbill, please understand that your insurance company will many not pay for missed or cancelled sessions. Telephone consultations between office visits are welcome. However, your therapist I will attempt to keep those contacts brief due to our my belief that important issues are better addressed within regularly scheduled sessions. You may leave a message for your therapist me at any time on his/her my confidential voicemail. If you wish your therapist me to return your call, please be sure to leave your name and phone number(s), along with a brief message concerning the nature of your call. Non-urgent phone calls are returned during normal workdays (Monday through Friday) within 24 hours. If you have an urgent need to speak with your therapistme, please indicate that fact in your message and follow any instructions that are provided by your therapist’s my voicemail. In the event of a medical emergency or an emergency involving a threat to your safety or the safety of others, please call 911 to request emergency assistance. These following resources are available in the local community to assist individuals who are in crisis: Suicide Prevention Hotline: (000) 000-0000 and (000) 000-0000 Psychiatric Emergency Treatment (PET team): (000) 000-0000 Shelter Availabilities: 211 (24 hours a day, 7 days a week) or (000) 000-0000 Domestic Violence Help: (000) 000-0000 Phone and email are the primary modes of communication between sessions. Non-urgent messages are returned during normal workdays (Monday through Friday) within 24 hours. Weekend calls or emails may be returned within 24 hours or on the next working day. I do not communicate via texts or through Internet networking sites. Unless otherwise agreed, texting is generally not a mode of communication I use in our therapeutic relationship. Please understand that I also do not interact with clients on Internet networking sites (examples include but are not limited to LinkedIn and Facebook). For your therapeutic benefit and feeling of safety, therapeutic boundaries are of utmost importance both during and after your treatment. Your physical health can have profound influence on your emotional well-being. For this reason, your are strongly encouraged to follow up on referrals for any additional services discussed. You are urged to have a physical examination to rule out any physical conditions causing or exacerbating your current emotional state. Similarly, it is your responsibility to keep current with your physical condition by receiving medical checkups and/or care. The standard of care for some diagnoses may strongly recommend you to have regular checkups with your doctor. If you are not willing to work with professionals, this therapist may not be able to supply you with the treatment you need in an outpatient psychotherapy setting. Therefore, if the therapy is not making required progress, I may choose to communicate with terminate the relationship and refer you by telephone, mail, to other sources of psychological or other meanspsychiatric care to help you to obtain different or higher level of care than the therapist can provide. Please indicate inform this me of any changes in your preference by checking one of the choices listed belowmedications, especially psychotropic medications. Please be sure to inform your therapist if you do not wish to be contacted at a particular time or place, or by a particular means. My therapist may send a fax to me. My fax number is: ( ) _ It is your therapist’s my intention to provide services that will assist you in reaching your goals. Based upon the information that you provide to your therapist me and the specifics of your situation, your therapist I will provide recommendations to you regarding your treatment. We I believe that therapists you and clients I are partners in the this therapeutic process. You have the right to agree or disagree with your therapist’s this my recommendations. Your therapist I will also periodically provide feedback to you regarding your progress and will invite your participation in the discussion. Please note that the process of therapy has many levels and can bring to light or exacerbate an issue(s) or uncomfortable feelings - meaning that sometimes “it may feel worse before it can start to feel better.” Due to the varying nature and severity of problems and the individuality of each patientclient, your therapist is I am unable to predict the length of your therapy or to guarantee a specific outcome or result. I do not participate in client’s legal proceedings as an advocate for a client. My policy is to not communicate with or write letters on behalf of the client to the court or lawyers for the purposes of a client’s litigation.

Appointment Scheduling and Cancellation Policies. Sessions are typically scheduled to occur one time per for once a week at the same time and day if possible. Your therapist may suggest a different amount of therapy more or less frequent sessions depending on the nature and severity of your concernssymptoms. Your consistent attendance greatly contributes to a successful outcome. In order to cancel or reschedule an appointment, you are expected to notify your therapist at least 24 hrs. in advance of your appointmentadvance. If you do not provide your therapist with at least 24 hours hour advance notice in advance, of cancellations you are will be responsible for payment for of the missed session. Please understand that your insurance company will not pay for missed or cancelled sessions. Telephone consultations between office visits are welcomemay be necessary at times. However, your therapist will attempt to keep those contacts brief due to our belief that important issues are better addressed within regularly scheduled sessions. Any telephone contact over 10 minutes in duration will be charged to you at the same rate as the session fees. You may leave a message for your therapist at any time on his/her confidential voicemail. If you wish your Your therapist cannot guarantee that calls will be returned immediately, but will make every effort to return your call, please be sure respond as soon as possible. Your therapist is unable to leave your name and phone number(s), along with a brief message concerning the nature of your call. Nonprovide 24-urgent phone calls are returned during normal workdays (Monday through Friday) within 24 hours. If you have an urgent need to speak with your therapist, please indicate that fact in your message and follow any instructions that are provided by your therapist’s voicemailhour crisis service. In the event of a Your therapist may need to communicate with that you by telephone, mailor your child is feeling unsafe, or other meansyou require immediate medical or psychological assistance, you should call 911 or go to the nearest emergency room. Please indicate your preference by checking one of the choices listed below. Please be sure to inform your therapist if you do not wish to be contacted at a particular time or place, or by a particular means. My therapist may send a fax to me. My fax number is: ( ) _ It is your therapist’s intention to provide services that will assist you or your child in reaching your goals. Based upon the information that you provide to your therapist and the specifics of your situation, your therapist will provide recommendations to you regarding your treatment. We believe that therapists and clients patients are partners in the therapeutic process. You have the right to agree or disagree with your therapist’s recommendations. Your therapist will also periodically provide feedback to you regarding your progress and will invite your participation in the discussion. Due to the varying nature and severity of problems and the individuality of each patient, your therapist is unable to predict the length of your therapy or to guarantee a specific outcome or result. Your therapist will not voluntarily participate in any litigation or custody dispute in which you and another individual, or entity, are parties. Your therapist has a policy of not communicating with your attorney, and generally will not write or sign letters, reports, declarations, or affidavits to be used in your legal matters. Your therapist will not provide records or testimony unless compelled to do so. If your therapist is court ordered to appear as a witness in an action involving you, you agree to reimburse your therapist for time spent for preparation, travel, or making a court appearance at the same rate as the session fees.

Appointment Scheduling and Cancellation Policies. Sessions are typically scheduled to occur one time per week at the same time and day if possible. Your therapist may suggest a different amount of therapy depending on the nature and severity of your concerns. Your consistent attendance greatly contributes to a successful outcome. In order to cancel or reschedule an appointment, you are expected to notify your therapist at least 24 hrs. in advance of your appointment. If you do not provide your therapist with at least 24 hours notice in advance, you are responsible for payment for the missed session. Please understand that your insurance company will not pay for missed or cancelled sessions. Telephone consultations between office visits are welcome. However, your therapist will attempt to keep those contacts brief due to our belief that important issues are better addressed within regularly scheduled during face-to-face sessions. Typically, any phone call that goes beyond 20 minutes, but is less then 45 minutes, would be billed at half the fee. Any longer phones sessions would be billed at the regular fee rate. You may leave a message for your therapist at any time on his/her confidential voicemail. If you wish would like your therapist to return your call, please be sure to leave your name and phone number(s)number, along with a brief message concerning the nature of your call. Non-urgent phone calls are returned during normal workdays (Monday through Friday) within approximately 24 – 48 hours. If you have an urgent need to speak with your therapist, please indicate that fact in your message and follow any instructions that are provided by your therapist’s voicemail. In the event of a Your therapist may need medical emergency or an emergency involving a threat to communicate with you by telephoneyour safety or the safety of others, mail, or other meansplease call 911 to request emergency assistance. Please indicate your preference by checking one of the choices listed below. Please be sure to inform your therapist if you do not wish to be contacted at a particular time or place, or by a particular means. My therapist may send a fax to me. My fax number is: ( ) _ It is your therapist’s intention to provide services that will assist you in reaching your goals. Based upon the information that you provide to your therapist and the specifics of your situation, your therapist will provide recommendations to you regarding your treatment. We believe that therapists Therapists and clients patients are partners in the therapeutic process. You have the right to agree or disagree with your therapist’s recommendations. Your therapist will also periodically provide feedback to you regarding your progress and will invite your participation in the discussion. Due to the varying nature and severity of problems and the individuality of each patient, your therapist is unable to predict the length of your therapy or to guarantee a specific outcome or result.

Appointment Scheduling and Cancellation Policies. Sessions are typically scheduled to occur one time per week at the same time and day if possible. Your therapist may suggest a different amount of therapy depending on the nature and severity of your concerns. Your consistent attendance greatly contributes to a successful outcome. In order to To cancel or reschedule an appointment, you are expected to notify your therapist Xxxxx Counseling Services, LLC at least 24 hrs. hours in advance of your appointment. If you do not provide your therapist with at least 24 hours 24-hour notice in advanceadvance except in case of sudden illness or family emergency, you are responsible for payment may be charged the late cancelation fee. In case of inclement weather or other closings your Xxxxx Counseling Services, LLC will post a notice on the homepage for the missed sessionagencies website, xxx.xxxxxxxxxxxxxxx.xxx and post a message on the outgoing voicemail. Please understand that your insurance company You will not pay be charged for missed or cancelled sessionsthis type of cancelation. Telephone consultations between office visits are welcome. However, your therapist will attempt to keep those contacts brief due to our belief that important issues are better addressed within regularly scheduled sessions. You may leave a message for your therapist at any time on his/her their confidential voicemail. If you wish for your therapist to return your call, please be sure to leave your name and phone number(s), along with a brief message concerning the nature of your call. Non-urgent phone calls are returned during normal workdays business hours (Monday through Friday) within 24 hours). If you have an urgent need to speak with your therapist, please indicate that fact in your message and follow any instructions that are provided by your therapist’s voicemail. In the event of a medical emergency or an emergency involving a threat to your safety or the safety of others, please call 911 to request emergency assistance. You may also visit the resources page on xxx.xxxxxxxxxxxxxxx.xxx or dial 211 to obtain information on services available in your area. Your therapist may need to communicate with you by telephone, mail, or other means. Please indicate your preference by checking one or multiple of the choices listed below. Please be sure to inform your therapist if you do not wish to be contacted at a particular time or place, or by a particular means. We utilize a third party for appointment reminders and your contact information will be shared with them for this purpose. Please check forms of communication you would like to be contacted by. ☐My therapist may call me at my home. My home phone number is: ☐My therapist may call me on my cell phone. My cell phone number is: ☐My therapist may call me at work. My work phone number is: ☐My therapist may send mail to me at my home address. ☐My therapist may send mail to me at my work address. ☐My therapist may communicate with me by email. My email address is: ☐My therapist may send a fax to me. My fax number is: ( ) _ It is your therapist’s intention to provide services that will assist you in reaching meeting your goals. Based upon the information that you provide to your therapist and the specifics of your situation, your therapist they will provide recommendations to you regarding your treatmenttreatment options. We believe that therapists and clients are partners in the therapeutic process. You have the right to agree or disagree with your therapist’s recommendations. Your therapist will also periodically provide feedback to you regarding your progress and will invite your participation in the discussion. Due to the varying nature and nature, severity of problems and the individuality of each patientclient, your therapist is unable to predict the length of your therapy or to guarantee a specific outcome or result.

Appointment Scheduling and Cancellation Policies. Sessions are typically scheduled to occur one time per a week at the same time and day if as much as possible. Your You and your therapist may suggest a different amount of therapy depending on the nature and severity of your concernscan discuss if more or less frequent sessions are appropriate. Your consistent attendance greatly contributes to a successful outcome. In order to cancel or reschedule an appointment, you are expected to notify your therapist at least 24 hrs. hours in advance of your appointment. If you do not provide your therapist with at least cancelation 24 hours notice in advance, you are responsible for payment for the missed session. Please understand that note: your insurance company will not pay for missed or cancelled sessions. Telephone consultations You are welcome to contact your therapist in between office visits are welcomesessions. However, your therapist will attempt to keep those contacts brief due to as a general rule, it is our belief that important issues are better addressed within regularly scheduled sessions. You may leave a message for your therapist at any time on his/her confidential voicemail. If you wish would like your therapist to tor return your call, call please be sure to and leave your name and phone number(snumber (s), along with a brief message concerning regarding the nature of your call. Non-urgent phone calls are will be returned during the therapist’s normal workdays (Monday through Friday) within 24 hoursworkday schedule, as soon as possible. If you have an feel it is urgent need to that you speak with your therapist, please indicate that fact in this information when leaving your message and follow any instructions that are provided by your therapist’s voicemail. In You may be charged for the event time the therapist spends communicating over the phone if the time exceeds 15 minutes. Please be sure to leave your name and phone number(s), and a brief message regarding the nature of a your call. Your therapist is typically available to return your call soon as possible during normal working days. Your therapist is not available to return calls after . Your therapist is not available to return calls on . Other: Your therapist may need to communicate with you by telephone, mail, telephone or other means. Please indicate your preference preferences by checking one of marking the choices listed boxes below. Please be sure to inform your therapist if indicate any days/times you do not wish to be contacted at a particular time or place, or by a particular meanscontacted. My therapist may call me on my home phone. Home phone #: My therapist may call me on my cell phone. Cell phone #: My therapist may send a fax text message to my cell phone. Cell phone #: My therapist may call me at work. Work phone #: *My therapist may email me. Email address: My fax number istherapist may send mail to my home address. Home address: ( ) _ It *Disclosure statement regarding text or email communication: Sensitive clinical information is to be discussed on the phone or in person. Potential risks of using electronic communication may include, but are not limited to; inadvertent sending of an email or text containing confidential information to the wrong recipient, theft or loss of the electronic devise, and interception by an unauthorized third party through an unsecured network. E-mail messages may contain viruses or other defects and it is your therapist’s intention responsibility to provide services ensure that will assist you in reaching your goalsit is virus-free. Based upon Additionally, e-mail or text communication may become a part of the information that you provide to your therapist and the specifics of your situation, your therapist will provide recommendations to you regarding your treatment. We believe that therapists and clients are partners in the therapeutic processclinical record. You have may be charged for the right time the therapist spends reading and responding to agree e-mail or disagree with your therapist’s recommendations. Your therapist will also periodically provide feedback to you regarding your progress and will invite your participation in the discussion. Due to the varying nature and severity of problems and the individuality of each patient, your therapist is unable to predict the length of your therapy or to guarantee a specific outcome or resulttext messages.

Appointment Scheduling and Cancellation Policies. Sessions are typically scheduled to occur one time per week at the same time and day if possible. Your therapist may suggest a different amount of therapy depending on the nature and severity of your concerns. Your consistent attendance greatly contributes to a successful outcome. In order to cancel or reschedule an appointment, you are expected to notify your therapist at least 24 hrs. hours in advance of your appointment. If you do not provide your therapist with at least 24 hours notice in advance, except in case of sudden illness or family emergency, you are responsible for payment for the missed session. Please understand that You are welcome to phone your insurance company will not pay for missed or cancelled therapist between sessions. Telephone consultations between office visits are welcome. However, your therapist will attempt to keep those contacts brief due to as a general rule, it is our belief that important issues are better addressed within regularly scheduled sessions. You may leave a message for your therapist at any time on his/her confidential voicemail. If you wish your therapist to return your call, please be sure to leave your name and phone number(s), along with a brief message concerning the nature of your call. Non-urgent phone calls are returned during normal workdays (Monday through Friday) within 24 hours. If you have an urgent need to speak with your therapist, please indicate that fact in your message and follow any instructions that are provided by your therapist’s voicemail. In You should also be aware of the event of a following resources that are available in the local community to assist individuals who are in crisis: Crisis Hotline: (000) 000-0000 Youth Shelter: (000) 000-0000 Domestic Violence Help: (000) 000-0000 Hospital: (000) 000-0000 Your therapist may need to communicate with you by telephone, mail, or other means. Please indicate your preference by checking one of the choices listed below. Please be sure to inform your therapist if you do not wish to be contacted at a particular time or place, or by a particular means. My Sensitive clinical information is to be discussed over the phone or in-person as deemed appropriate by your therapist. For appropriate e-mail or text communication your therapist will respond to your e-mail or text within 24 hours. Potential risks of using electronic communication may send a fax include, but are not limited to, inadvertent sending of an e-mail or text containing confidential information to methe wrong recipient, theft or loss of the computer, laptop or mobile device storing confidential information, and interception by an unauthorized third party through an unsecured network. My fax number is: ( ) _ E-mail messages may contain viruses or other defects and it is your responsibility to ensure that it is virus-free. In addition, e-mail or text communication may become part of the clinical record. You may be charged for time your therapist spends reading and responding to e-mail or text messages. It is your therapist’s intention to provide services that will assist you in reaching your goals. Based upon the information that you provide to your therapist and the specifics of your situation, your therapist will provide recommendations to you regarding your treatment. We believe that therapists and clients are partners in the therapeutic process. You have the right to agree or disagree with your therapist’s recommendations. Your therapist will also periodically provide feedback to you regarding your progress and will invite your participation in the discussion. Due Your therapist will work with you to develop an effective treatment plan. Over the course of therapy, your therapist will attempt to evaluate whether the therapy provided is beneficial to you. Your feedback and input is an important part of this process. It is the goal of your therapist to assist you in effectively addressing your problems and concerns. However, due to the varying nature and severity of problems and the individuality of each patientclient, your therapist is unable to predict the length of your therapy or to guarantee a specific outcome or result. Telehealth is a mode of delivering health care services, including psychotherapy, via communication technologies such as the Internet or phone. There are risks associated with participating in Telehealth including, but not limited to, the possibility, despite reasonable efforts and safeguards on the part of your therapist, that your psychotherapy sessions and transmission of your treatment information could be disrupted or distorted by technical failures. You understand that there is a risk of being overheard by persons near you and that you are responsible for using a location that is private and free from distractions or intrusions. Although some Telehealth platforms allow for video or audio recordings, neither you nor your therapist may record the sessions without the other party’s written permission. If needed, your therapist will make reasonable efforts to ascertain and provide you with emergency resources in your geographic area. If you require emergency care, you understand that you may call 911 or proceed to the nearest hospital emergency room for assistance.