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Common use of TELEPHONE & EMERGENCY PROCEDURES Clause in Contracts

TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xx. XxXxxxxxx between sessions, please leave a message on his confidential voice mail-box (000) 000-0000 and your call will be returned as soon as possible. Xx. XxXxxxxxx checks his messages a few times a day, unless he is out of town. If an emergency situation arises, please indicate it clearly in your message. If you need to talk to someone right away, you can call Xx. Xxxxx Xxxxxxxx at (000) 000-0000, the Orange County 24-hour crisis hot line (000) 000-0000, or the Police (911). PAYMENTS & INSURANCE REIMBURSEMENT: Clients are expected to pay the standard fee of $ per 55 minute session at the end of each session or at the end of the month unless other arrangements have been made. Telephone conversations, site visits, report writing and reading, consultation with other professionals, release of information, reading records, longer sessions, travel time, etc... will be charged at the same rate, unless indicated and agreed otherwise. Please notify Xx. XxXxxxxxx if any problem arises during the course of therapy regarding your ability to make timely payments. Clients who carry insurance should remember that professional services are rendered and charged to the clients and not to the insurance company. Unless agreed upon differently, Xx. XxXxxxxxx will provide you with a copy of your receipt on a monthly basis, which you can then submit to your insurance company for reimbursement if you so choose. As was indicated in the section Health Insurance & confidentiality of records, you must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk. Not all issues/conditions/problems, which are the focus of psychotherapy, are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coverage.

Appears in 2 contracts

Samples: Office Policies & General Information Agreement for Psychotherapy Services, Office Policies & General Information Agreement for Psychotherapy Services

TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xx. XxXxxxxxx Xxxxxxx between sessions, please leave a message on his confidential voice mail-box at the answering service (000) 000000)000-0000 and your call will be returned as soon as possible. Xx. XxXxxxxxx Xxxxxxx checks his her messages a few times a dayduring the daytime only, unless he she is out of town. If an emergency situation arises, please indicate it clearly in your message. If message and if you need to talk to someone right away, you can away call XxPsychiatric Emergency Services. (Santa Xxxxx Xxxxxxxx at County): (000) 000-0000, the Orange County 24-hour suicide crisis hot line (Santa Xxxxx County): 0 (000) 000-0000, 0000 or the Police (Police: 911). Please do not use email or faxes for emergencies. Xx. Xxxxxxx does not always check her email or faxes daily. PAYMENTS & INSURANCE REIMBURSEMENT: Clients are expected to pay the standard fee of $ $175.00 per 55 minute session at the end 50 minutes for individual therapy or $200 per 50 minutes of each session or couple’s therapy at the end of the month session, unless other arrangements have been made. Telephone conversations, site visits, report writing and readingreading of reports, consultation with other professionals, release of information, reading records, longer sessions, travel time, etc... . will be charged at the same rate, unless indicated and agreed upon otherwise. Please notify Xx. XxXxxxxxx Xxxxxxx promptly if any problem arises problems arise during the course of therapy regarding your ability to make timely payments. Clients who carry insurance should remember that professional services are rendered and charged to the clients and not to the insurance companycompanies. Unless agreed upon differently, Xx. XxXxxxxxx Xxxxxxx will provide you with a copy of your receipt on a monthly basis, which you can then submit to your insurance company for reimbursement reimbursement, if you so choose. As was indicated in the section section, Health Insurance & confidentiality Confidentiality of recordsRecords, you must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk. Not all issues/conditions/problems, which are the focus of dealt with in psychotherapy, are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coverage. If your account is overdue (unpaid) and there is no written agreement on a payment plan, Xx. Xxxxxxx can use legal or other means (courts, collection agencies, etc.) to obtain payment.

Appears in 1 contract

Samples: Office Policies & General Information Agreement for Psychotherapy Services

TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xx. XxXxxxxxx me between sessions, please leave a message on his confidential voice mail-box my voicemail or a text at (000) 000-0000 (not any other number, fax, or email) and I will return your call will be returned as soon as possible. XxI respond more quickly to text messages. XxXxxxxxx checks his I try to check messages a few times a dayregularly, unless he is I am out of town, but I may not always get your message in a timely manner. I do not check messages during the night. Messages are checked less frequently on weekends and holidays. If an emergency situation arises, please indicate it clearly in your message. If you need to talk to someone right away, you can You may also call Xx. Xxxxx Xxxxxxxx at (000) 000-0000, the Orange County 24-hour crisis hot line (000) 000-0000, 0000 or the Police (911). PAYMENTS & INSURANCE REIMBURSEMENT: Clients are expected to pay the standard fee of $ per 55 minute $250 for an intake session and $195 for a regular session or their individual deductible and/or co-payment at the end of each session or at the end of the month psychotherapy session, unless other arrangements have been made. Balances over 30 days overdue will be charged late fees of $25/month. Checks are to be made payable to Xxxxxx Xxxxxxx, Ph.D. Telephone conversations, site visits, report report-writing and reading, consultation with other professionals, release of information, reading records, longer sessions, travel time, etc... . will be charged at the same rate, unless indicated and agreed otherwise. Court appearances and testimonies are charged at different rates plus travel time/expenses. Please notify Xx. XxXxxxxxx me if any problem arises during the course of therapy regarding your ability to make timely payments. Clients who If you carry insurance should insurance, please remember that professional services are rendered and charged to the clients you and not to the insurance companycompanies. Unless agreed upon differently, Xx. XxXxxxxxx will provide you with a copy of your receipt on a monthly basis, which you can then submit to your insurance company for reimbursement if you so choose. As was indicated in the section Health Insurance & confidentiality of records, you must be Be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk. Not Insurance companies do not reimburse for all issues/conditions/problems, which problems that are the focus of psychotherapy, are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coverage.coverage with your insurance company, since ultimately you are financially responsible for sessions not reimbursed by your medical insurance. We will be happy to bill your insurance company; however, if your insurance company does not pay within 60 days or declines to pay, you may be asked to pay a portion or all of your outstanding bill, which will be refunded to you if and when your insurance pays. Statements submitted to insurance companies must be billed payable to Xxxxxx Xxxxxxx, Ph.D.

Appears in 1 contract

Samples: Office Policies & General Information Agreement for Psychotherapy Services

TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xx. XxXxxxxxx between Xxxxx Xxxxxxxx be- tween sessions, please leave a message on his confidential voice mail-box at (000) 000-0000 and your call will be returned as soon as possible. Xx. XxXxxxxxx Xxxxx Xxxxxxxx checks his her messages a few times a dayduring the daytime only, unless he she is out of town. If an emergency situation arises, please indicate it clearly in your message. If message and if you need to talk to someone right away, you can away call Xx. Xxxxx Xxxxxxxx at (000) 000-0000, the Orange County 24-hour crisis hot line Riverside Community Care emergency ser- vices: (000) 000-0000, or the Police (Police: 911). You and also proceed safety to Norwood Hospital Emergency Room. Please do not use email or faxes for emergencies. PAYMENTS & INSURANCE REIMBURSEMENT: Clients are expected to pay the standard fee of $ $140 per 55 minute hour session for individual treatment and $175 per hour for couples/family treatment at the end of each session or at the end of the month unless other arrangements have been made. Telephone conversationsconversa- tions, site visits, report writing and readingreading of reports, consultation with other professionals, release of information, reading records, longer sessions, travel time, etc... . will be charged at the same rate, unless indicated and agreed upon otherwise. Please notify Xx. XxXxxxxxx Xxxxx Xxxxxxxx if any problem arises problems arise during the course of therapy regarding your ability to make timely payments. Clients who carry insurance should remember that professional services are rendered and charged to the clients and not to insurance com- panies first but ultimately the insurance company. Unless agreed upon differently, Xx. XxXxxxxxx will provide you with a copy of your receipt on a monthly basis, which you can then submit to your insurance company client is responsible for reimbursement if you so chooseany unpaid/uncovered treatment. As was indicated in the section section, Health Insurance & confidentiality Confidentiality of recordsRecords, you must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk. Not all issues/conditions/problems, which are the focus of dealt with in psychotherapy, are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coverage. If your account is overdue (unpaid) and there is no written agreement on a payment plan, Xx. Xxxxx Xxxxxxxx can use legal or other means (courts, collection agencies, etc.) to obtain payment.

Appears in 1 contract

Samples: Office Policies and General Information Agreement for Psychotherapy Services Consent for Psychotherapy

TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xx. XxXxxxxxx Xxxxxxx between sessions, please leave a message on his my confidential voice mail-box voicemail. (000) 000-0000 and text me stating that your call needs are urgent. I will be returned respond as soon as possible. Xx. XxXxxxxxx Xxxxxxx checks his her messages a few times a day, during the daytime unless he she is out of town. If an emergency situation arises, please indicate it clearly in your message. If arises and you need to talk to someone right away, you can call XxPsychiatric Emergency Services. Xxxxx Xxxxxxxx at Santa Xxxx: (000) 000-0000, the Orange County 0000 to access a 24-hour crisis hot line (000) 000-0000, or the Police (call 911). PAYMENTS & INSURANCE REIMBURSEMENT: Please do not use email for emergencies. Xx. Xxxxxxx does not always check her email. Clients are expected to pay the standard fee of $ $165.00 per 55 45-minute individual session or $185.00 per couples’ session at the end of each session or at the end Beginning of the month session unless other arrangements have been made. Telephone conversations, site visits, report writing and readingreading of reports, consultation with other professionals, release of information, reading records, longer sessions, travel time, etc... . will be charged at the same rate, unless indicated and agreed upon otherwise. Please notify Xx. XxXxxxxxx Xxxxxxx if any problem arises problems arise during the course of therapy regarding your ability to make timely payments. Clients who carry insurance should remember that professional services are rendered and charged to the clients and not to the insurance companycompanies. Unless agreed upon differently, Xx. XxXxxxxxx Xxxxxxx will provide you with a copy of your receipt on a monthly basis, which you can then submit to your insurance company for reimbursement reimbursement, if you so choose. As was indicated in the section section, Health Insurance & confidentiality Confidentiality of recordsRecords, you must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk. Not all issues/issues/ conditions/problems, which are the focus of dealt with in psychotherapy, are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coverage. If your account is overdue (unpaid) and there is no written agreement on a payment plan, Xx. Xxxxxxx can use legal or other means (courts, collection agencies, etc.) to obtain payment. Participation in therapy can result in a number of benefits to you, including improving interpersonal relationships and resolution of the specific concerns that led you to seek therapy. Working toward these benefits, however, requires effort on your part. Psychotherapy requires your very active involvement, honesty, and openness in order to change your thoughts, feelings, and/or behavior. Xx. Xxxxxxx will ask for your feedback and views on your therapy, its progress, and other aspects of the therapy and will expect you to respond openly and honestly. Sometimes more than one approach can be helpful in dealing with a certain situation. During evaluation or therapy, remembering or talking about unpleasant events, feelings, or thoughts can result in you experiencing considerable discomfort or strong feelings of anger, sadness, worry, fear, etc., or experiencing anxiety, depression, insomnia, etc.

Appears in 1 contract

Samples: Informed Consent for Psychotherapy

TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xx. XxXxxxxxx Xxxxxx Xxxxxxxxx, LCPC between sessions, please leave a message on his confidential voice mail-box at the answering service (000) 000-0000 and your call will be returned as soon as possible. Xx. XxXxxxxxx Xxxxxx Xxxxxxxxx, LCPC checks his her messages a few times a dayduring the daytime only, unless he she is out of town. If an emergency situation arises, please indicate it clearly in your message. If message and if you need to talk to someone right awayaway call your local Emergency Room or 24-hour crisis line at Xxxxxx Sierra, you can call Xx. Xxxxx Xxxxxxxx at Inc: (000) 000-0000, the Orange County 24-hour crisis hot line (000) 000-0000, 0000 or the Police (Police: 911). Please do not use email or faxes for emergencies. Xxxxxx Xxxxxxxxx, LCPC does not always check his/her email or faxes daily. PAYMENTS & INSURANCE REIMBURSEMENT: Clients are expected to pay the standard fee of $ $200.00 per 55 50-minute session at the end of each session or at the end of the month unless other arrangements have been made. Telephone conversations, site visits, report writing and readingreading of reports, consultation with other professionals, release of information, reading records, longer sessions, travel time, etc... . will be charged at the same rate, unless indicated and agreed upon otherwise. Please notify Xx. XxXxxxxxx Xxxxxx Xxxxxxxxx, LCPC if any problem arises problems arise during the course of therapy regarding your ability to make timely payments. Clients who carry insurance should remember that professional services are rendered and charged to the clients and not to the insurance company. Unless agreed upon differently, Xx. XxXxxxxxx will provide you with a copy of your receipt on a monthly basis, which you can then submit to your insurance company for reimbursement if you so choosecompanies. As was indicated in the section section, Health Insurance & confidentiality Confidentiality of recordsRecords, you must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk. Not all issues/conditions/problems, which are the focus of dealt with in psychotherapy, are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coverage. If your account is overdue (unpaid) and there is no written agreement on a payment plan, Xxxxxx Xxxxxxxxx, LCPC can use legal or other means (courts, collection agencies, etc.) to obtain payment.

Appears in 1 contract

Samples: Office Policies & General Information Agreement for Psychotherapy Services

TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xx. XxXxxxxxx (Xxxxxxxx Xxxxx, LCSW-R) between sessions, please leave a message on his confidential voice mail-box (000) at 000-0000 and your 000-0000. Your call will be returned as soon as possible. Xx. XxXxxxxxx (Xxxxxxxx Xxxxx, LCSW-R) checks his his/her messages a few times a dayduring the daytime only, unless s/he is out of town. If an emergency situation arises, please indicate it clearly in your message. If message and if you need to talk to someone right away, you can away call Xx. Xxxxx Xxxxxxxx the national suicide prevention line at (0-000) -000-0000) or NYC well at 1-888 NYC well if you need mor local help: If you or someone you know is having an immediate emergency, the Orange County 24call 911 or go to your nearest emergency room. Please do not use email or faxes for emergencies. (Xxxxxxxx Xxxxx, LCSW-hour crisis hot line (000R) 000-0000, does not always check his/her email or the Police (911)faxes daily. PAYMENTS & INSURANCE REIMBURSEMENT: Clients are expected to pay the standard fee of $ $200.00 per 55 50 minute or $225 per hour/intake session via the HIPAA complaint credit card processing company known as IvyPay at the end beginning of each session session. I do offer 15-minute check ins with parents or guardians that are charged as consultations at ¼ the end hour for a fee of the month unless other arrangements have been made. Telephone telephone conversations, site or $50. Site visits, report writing and readingreading of reports, consultation with other professionals, release of information, reading records, longer sessions, travel time, etc... . will be charged at the same rate, unless indicated and agreed otherwise$50 per half hour. Please notify Xx. XxXxxxxxx (Xxxxxxxx Xxxxx, LCSW-R) if any problem arises problems arise during the course of therapy regarding your ability to make timely payments. Clients who carry insurance should remember that professional services are rendered and charged to the clients and not to the insurance companycompanies. Unless agreed upon differently, Xx. XxXxxxxxx (Xxxxxxxx Xxxxx, LCSW-R) will provide you with a copy of your receipt on a monthly weekly basis, which you can then submit to your insurance company for reimbursement reimbursement, if you so choose. As was indicated in the section section, Health Insurance & confidentiality Confidentiality of recordsRecords, you must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk. Not all issues/conditions/problems, which are the focus of dealt with in psychotherapy, are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coverage. If your account is overdue (unpaid) and there is no written agreement on a payment plan, (Xxxxxxxx Xxxxx, LCSW-R) can use legal or other means (courts, collection agencies, etc.) to obtain payment. THE PROCESS OF THERAPY/EVALUATION AND SCOPE OF PRACTICE: Participation in therapy can result in a few benefits to you, including improving interpersonal relationships and resolution of the specific concerns that led you to seek therapy. Working toward these benefits, however, requires effort on your part. Psychotherapy requires your very active involvement, honesty, and openness to change your thoughts, feelings, and/or behavior. (Xxxxxxxx Xxxxx, LCSW-R) will ask for your feedback and views on your therapy, its progress, and other aspects of the therapy and will expect you to respond openly and honestly. Sometimes more than one approach can be helpful in dealing with a certain situation. During evaluation or therapy, remembering or talking about unpleasant events, feelings, or thoughts can result in you experiencing considerable discomfort or strong feelings of anger, sadness, worry, fear, etc., or experiencing anxiety, depression, insomnia, etc. (Xxxxxxxx Xxxxx, LCSW-R) may challenge some of your assumptions or perceptions or propose different ways of looking at, thinking about, or handling situations, which can cause you to feel very upset, angry, depressed, challenged, or disappointed. Attempting to resolve issues that brought you to therapy in the first place, such as personal or interpersonal relationships, may result in changes that were not originally intended. Psychotherapy may result in decisions about changing behaviors, employment, substance use, schooling, housing, or relationships. Sometimes a decision that is positive for one family member is viewed quite negatively by another family member. Change will sometimes be easy and swift, but more often it will be slow and even frustrating. There is no guarantee that psychotherapy will yield positive or intended results. During the course of therapy, (Xxxxxxxx Xxxxx, LCSW-R) is likely to draw on various psychological approaches according, in part, to the problem that is being treated and his/her assessment of what will best benefit you. These approaches include, but are not limited to, behavioral, cognitive-behavioral, cognitive, psychodynamic, existential, system/family, developmental (adult, child, family), humanistic or psycho-educational. (Xxxxxxxx Xxxxx, LCSW-R) provides neither custody evaluation recommendation nor medication or prescription recommendation nor legal advice, as these activities do not fall within his scope of practice.

Appears in 1 contract

Samples: Office Policies & General Information Agreement for Psychotherapy Services

TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xx. XxXxxxxxx Xxxx Xxxxxxx, MFT between sessions, please leave a message on his confidential voice mail-box at the answering service (000) 000-0000 and your call will be returned as soon as possible. Xx. XxXxxxxxx Xxxx Xxxxxxx, MFT checks his his/her messages a few times a dayduring the daytime only, unless he is out of town. If an emergency situation arises, please indicate it clearly in your message. If message and if you need to talk to someone right away, you can away call Xx. Xxxxx Xxxxxxxx at San Bernardino County Crisis Walk-in Center M-F (000) 000-0000 or 24 Hour (000) 000-0000, the Orange County 24-hour crisis hot line (000951) 000-0000, 686- 4357 or the Police (Police: 911). Please do not use email or faxes for emergencies. Xxxx Xxxxxxx, MFT does not always check his email or faxes daily. PAYMENTS & INSURANCE REIMBURSEMENT: Clients are expected to pay the standard fee of $ $125.00 per 55 50 minute session at before the end beginning of each session or at the end of the month unless other arrangements have been made. Telephone conversations, site visits, report writing and readingreading of reports, consultation with other professionals, release of information, reading records, longer sessions, travel time, etc... . will be charged at the same rate, unless indicated and agreed upon otherwise. Please notify Xx. XxXxxxxxx Xxxx Xxxxxxx, MFT if any problem arises problems arise during the course of therapy regarding your ability to make timely payments. I do not accept regular health insurance or Medi- Cal. Clients who carry insurance should remember that professional services are rendered and charged to the clients and not to the insurance companycompanies. Unless agreed upon differently, Xx. XxXxxxxxx Xxxx Xxxxxxx, MFT will provide you with a copy of your receipt on a monthly basis, which you can then submit to your insurance company for reimbursement reimbursement, if you so choose. As was indicated in the section section, Health Insurance & confidentiality Confidentiality of recordsRecords, you must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk. Not all issues/issues/ conditions/problems, which are the focus of dealt with in psychotherapy, are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coverage. If your account is overdue (unpaid) and there is no written agreement on a payment plan, Xxxx Xxxxxxx, MFT can use legal or other means (courts, collection agencies, etc.) to obtain payment.

Appears in 1 contract

Samples: Informed Consent for Psychotherapy

TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xx. XxXxxxxxx Xxxxxxxxx between sessions, please leave a message on his confidential Xx. Xxxxxxxxx’x voice mail-box (000) , 000-0000 000-0000, and your call will be returned as soon as possible. Xx. XxXxxxxxx Xxxxxxxxx checks his her messages a few times a throughout the day, unless he she is out of out-of-town. If an emergency situation arises, please indicate it clearly in your message. If you need to talk to someone right away, you can call Xx. Xxxxx Xxxxxxxx at (000) 000-0000, go to the Orange County 24-hour crisis hot line (000) 000-0000closest emergency room for a clinical emergency, or call the Police (police at 911). PAYMENTS & INSURANCE REIMBURSEMENTREIMBURSEMENTS: Xx. Xxxxxxxxx bills clients on an agreed upon hourly fee with each client. Clients are expected to pay the standard Xx. Xxxxxxxxx their contracted hourly fee of $ per 55 minute session at the end time of each session or at the end of the month unless other arrangements have been madevisit. Telephone conversations, site visits, report writing and reading, consultation with other professionals, release of information, reading records, longer sessions, travel time, time etc... . will be charged and billed at the same rate, unless indicated and agreed to otherwise. Please notify Xx. XxXxxxxxx Xxxxxxxxx if any problem arises problems arise during the course of therapy regarding your ability to make timely time payments. Clients who carry insurance should remember that professional services are rendered and charged to the clients and not to the insurance companycompanies. Unless agreed upon differently, Xx. XxXxxxxxx Xxxxxxxxx, if requested, will provide you with a copy of your receipt on a monthly basis, statement which you can then submit be submitted to your insurance company for reimbursement if you so choosecompany. As was indicated in the section Health Insurance & confidentiality Confidentiality of recordsRecords” section, you must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk. Not all issues/conditions/problems, problems which are the focus of psychotherapy, psychotherapy are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coverage.

Appears in 1 contract

Samples: Office Policies & General Information Agreement for Psychotherapy Services

TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xx. XxXxxxxxx Xxxxxx between sessions, please leave a message on his confidential voice mail-box the answering service (000) 000-0000 and your call will be returned as soon as possible. Xx. XxXxxxxxx Xxxxxx checks his messages a few times a dayduring the daytime only, unless he is out of town. If an emergency situation arises, please indicate it clearly in your message. If message and if you need to talk to someone right away, you can away call XxPsychiatric Emergency Services. Xxxxx Xxxxxxxx at (000Los Angeles): (800) 000-0000, the Orange County 24-hour crisis hot line (000) 000-0000854- 7771, or the Police (Police: 911). PAYMENTS Please do not use e-mail for emergencies. Xx. Xxxxxx does not always check his e-mail daily. Payments & INSURANCE REIMBURSEMENTInsurance Reimbursement: Clients are expected to pay the standard fee of $ $150.00 per 55 45 minute or $200.00 per hour session at the end of each session or at the end of the month unless other arrangements have been made. Telephone conversations, site visits, report writing and reading, consultation with other professionals, release of information, reading records, longer sessions, travel time, etc... . will be charged at the same rate, unless indicated and agreed upon otherwise. Please notify Xx. XxXxxxxxx Xxxxxx if any problem arises problems arise during the course of therapy regarding your ability to make timely payments. Clients who carry insurance should remember that professional services are rendered and charged to the clients and not to the insurance companycompanies. Unless agreed upon differently, Xx. XxXxxxxxx Xxxxxx will provide you with a copy of your receipt on a monthly per-session basis, which you can then submit to your insurance company Mediation & Arbitration: All disputes arising out of or in relation to this agreement to provide psychotherapy services shall first be referred to mediation, before, and as a pre-condition of, the initiation of arbitration. The mediator shall be a neutral third party chosen by agreement of Xx. Xxxxxx and client(s). The cost of such mediation, if any, shall be split equally, unless otherwise agreed upon. In the event that mediation is unsuccessful, any unresolved controversy related to this agreement should be submitted to and settled by binding arbitration in Sacramento County, CA in accordance with the rules of the American Arbitration Association which are in effect at the time the demand for reimbursement if you so choosearbitration is filed. As was indicated Notwithstanding the foregoing, in the section Health Insurance & confidentiality event that your account is overdue (unpaid) and there is no agreement on a payment plan, Xx. Xxxxxx can use legal means (court, collection agency, etc.) to obtain payment. The prevailing party in arbitration or collection proceeding shall be entitled to recover a reasonable sum as and for attorneys’ fees. In the case of recordsarbitration, you must be aware the arbitrator will determine that submitting a mental health invoice for reimbursement carries a certain amount of risk. Not all issues/conditions/problems, which are the focus of psychotherapy, are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coveragesum.

Appears in 1 contract

Samples: Office Policies & General Information Agreement for Psychotherapy Services

TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xx. XxXxxxxxx Xxxxxxxx Xxxxxx Xxxxxxx Xxxxx between sessions, please leave a message on his confidential voice mail-box her answering machine (000831) 000-000- 0000 and your call will be returned as soon as possible. XxYou may also send an email to XxxxxxxxXxxxxXXX@xxxxx.xxx and text to: 000-000-0000. XxXxxxxxx Xxxxxxxx Xxxxxx Xxxxxxx Xxxxx checks his her messages a few times a dayduring the daytime only, unless s/he is out of town. If an emergency situation arises, please indicate it clearly in your message. If message and if you need to talk to someone right away, you can away call XxPsychiatric Emergency Services. Xxxxx Xxxxxxxx at Santa Xxxx: (000) 000-0000, the Orange County 24-hour crisis hot line (000) 000-0000for Santa Xxxx, or the Police (Police: 911). Please do not use email or faxes for emergencies. Xxxxxxxx Xxxxxx Xxxxxxx Xxxxx does not always check her faxes daily and must turn on a machine to receive them. PAYMENTS & INSURANCE REIMBURSEMENT: Clients are expected to pay the standard fee of $ $150.00 per 55 45-50 minute or $180.00 per hour session at the end beginning of each session or at the end of the month unless other arrangements have been madesession; add $5 if paying by credit card. Telephone conversations, site visits, report writing and readingreading of reports, consultation with other professionals, release of information, reading records, longer sessions, travel time, etc... . will be charged at the same rate, unless indicated and agreed upon otherwise. Please notify Xx. XxXxxxxxx Xxxxxxxx Xxxxxx Xxxxxxx Xxxxx if any problem arises problems arise during the course of therapy regarding your ability to make timely payments. Clients who carry insurance should remember that professional services are rendered and charged to the clients and not to the insurance companycompanies. Unless agreed upon differently, Xx. XxXxxxxxx Xxxxxxxx Xxxxxx Xxxxxxx Xxxxx will provide you with a copy of your receipt on a monthly basis, which you can then submit to your insurance company for reimbursement reimbursement, if you so choose. As was indicated in the section section, Health Insurance & confidentiality Confidentiality of recordsRecords, you must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk. Not all issues/conditions/problems, which are the focus of dealt with in psychotherapy, are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coverage. If your account is overdue (unpaid) and there is no written agreement on a payment plan, Xxxxxxxx Xxxxxx Xxxxxxx Xxxxx can use legal or other means (courts, collection agencies, etc.) to obtain payment.

Appears in 1 contract

Samples: Office Policies & General Information Agreement for Psychotherapy Services

TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xx. XxXxxxxxx Xxxxxxx between sessions, please leave a message on his confidential voice mail-box at the answering service (000) 000-0000 and your call will be returned as soon as possible. Xx. XxXxxxxxx Xxxxxxx checks his her messages a few times a dayduring the daytime only, unless he she is out of town. If an emergency situation arises, please indicate it clearly in your message. If message and if you need to talk to someone right away, you can away call Xx. Xxxxx Xxxxxxxx at the 24-hour GA crisis line: (000) 000-0000, the Orange County 24-hour crisis hot line (000) 000-0000, 0000 or the Police (Police: 911). Please do not use email or faxes for emergencies. Xx. Xxxxxxx does not always check her email or faxes daily. PAYMENTS & INSURANCE REIMBURSEMENT: Clients are expected to pay the standard fee of $ $150.00 per 55 45-60 minute session at the end of each session or at the end of the month unless other arrangements have been made. Telephone conversations, site visits, report writing and readingreading of reports, consultation with other professionals, release of information, reading records, longer sessions, travel time, etc... . will also be charged at the same ratecharged, unless indicated and agreed upon otherwise. Please notify Xx. XxXxxxxxx Xxxxxxx if any problem arises problems arise during the course of therapy regarding your ability to make timely payments. Clients who carry insurance should remember that professional services are rendered and charged to the clients and not to the insurance companycompanies. Unless agreed upon differently, Xx. XxXxxxxxx Xxxxxxx will provide you with a copy of your receipt on a monthly basis, which you can then submit to your insurance company for reimbursement reimbursement, if you so choose. As was indicated in the section section, Health Insurance & confidentiality Confidentiality of recordsRecords, you must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk. Not all issues/conditions/problems, which are the focus of dealt with in psychotherapy, are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coverage. If your account is overdue (unpaid) and there is no written agreement on a payment plan, Xx. Xxxxxxx can use legal or other means (courts, collection agencies, etc.) to obtain payment. THE PROCESS OF THERAPY/EVALUATION AND SCOPE OF PRACTICE: Participation in therapy can result in a number of benefits to you, including improving interpersonal relationships and resolution of the specific concerns that led you to seek therapy. Working toward these benefits, however, requires effort on your part. Psychotherapy requires your very active involvement, honesty, and openness in order to change your thoughts, feelings, and/or behavior. Xx. Xxxxxxx will ask for your feedback and views on your therapy, its progress, and other aspects of the therapy and will expect you to respond openly and honestly. Sometimes more than one approach can be helpful in dealing with a certain situation. During evaluation or therapy, remembering or talking about unpleasant events, feelings, or thoughts can result in you experiencing considerable discomfort or strong feelings of anger, sadness, worry, fear, etc., or experiencing anxiety, depression, insomnia, etc. Xx. Xxxxxxx may challenge some of your assumptions or perceptions or propose different ways of looking at, thinking about, or handling situations, which can cause you to feel very upset, angry, depressed, challenged, or disappointed. Attempting to resolve issues that brought you to therapy in the first place, such as personal or interpersonal relationships, may result in changes that were not originally intended. Psychotherapy may result in decisions about changing behaviors, employment, substance use, schooling, housing, or relationships. Sometimes a decision that is positive for one family member is viewed quite negatively by another family member. Change will sometimes be easy and swift, but more often it will be slow and even frustrating. There is no guarantee that psychotherapy will yield positive or intended results. During the course of therapy, Xx. Xxxxxxx is likely to draw on various psychological approaches according, in part, to the problem that is being treated and her assessment of what will best benefit you. These approaches include, but are not limited to, behavioral, cognitive-behavioral, cognitive, psychodynamic, existential, system/family, developmental (adult, child, family), humanistic or psycho-educational.

Appears in 1 contract

Samples: Informed Consent for Psychotherapy

TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xx. XxXxxxxxx Xxxx Xxxxxx, LPC between sessions, please leave a message on his confidential voice mail-box at the answering service (000602) 000-0000 734- 0192 or email (preferred) and your call message will be returned as soon as possible. Xx. XxXxxxxxx Xxxx Xxxxxx, LPC checks his messages a few times a dayduring the daytime only, unless he she is out of town. If an emergency situation arises, please indicate it clearly in your message. If you need on vacation, and/or not scheduled to talk to someone right away, you can call Xx. Xxxxx Xxxxxxxx at (000) 000-0000, the Orange County 24-hour crisis hot line (000) 000-0000, or the Police (911)work. PAYMENTS & INSURANCE REIMBURSEMENT: Clients are expected to pay the standard fee of $ $165 for intakes, $130 per 55 45 minute therapy session or $150.00 per hour therapy session at the end of each session or at the end of the month prior to each session unless other arrangements have been made. Hypnotherapy is $165. The fees are standard for therapy unless other fees have been agreed upon by both Xxxx Xxxxxx and the client such as in the case of financial hardship. The no-show fee, missed appointment or late cancellation fee with under 24 hours notice is the full session fee or minimum of $75 unless other arrangements were made. Xxxx Xxxxxx, LPC may automatically charge your card on file for missed/late cancel/or no-shows appointment unless other arrangements have been agreed upon between you and Xxxx Xxxxxx, LPC. Telephone conversations, site visits, report writing and readingreading of reports, consultation with other professionals, release of information, reading records, longer sessions, travel time, etc... . will be charged at the same rate, unless indicated and agreed upon otherwise. Please notify Xx. XxXxxxxxx Xxxx Xxxxxx, LPC if any problem arises problems arise during the course of therapy regarding your ability to make timely payments. Clients who carry insurance should remember that professional services are rendered and charged to the clients and not to the insurance companycompanies if not contracted with Kara. Unless agreed upon differentlyXxxx Xxxxxx, Xx. XxXxxxxxx LPC will provide you with a copy of your receipt on a monthly basis, per your request which you can then submit to your insurance company for reimbursement reimbursement, if you so choose. IF Xxxx Xxxxxx, LPC is contracted by insurance companies to bill an insurance panel directly, then Xxxx will collect your co-pay or deductible. If Xxxx Xxxxxx, LPC bills insurance for you as a courtesy, she may hire a medical xxxxxx to assist in this billing insurance process. This medical xxxxxx is trained in HIPPA and client confidentiality. As was indicated in the section section, Health Insurance & confidentiality Confidentiality of recordsRecords, you must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk. Not all issues/conditions/problems, which are the focus of dealt with in psychotherapy, are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coverage. If your account is overdue (unpaid) and there is no agreement on a payment plan, Xxxx Xxxxxx LPC can terminate therapy. change your thoughts, feelings, and/or behavior. Xxxx Xxxxxx, LPC will ask for your feedback and views on your therapy, its progress, and other aspects of the therapy and will expect you to respond openly and honestly. Sometimes more than one approach can be helpful in dealing with a certain situation. During evaluation or therapy, remembering or talking about unpleasant events, feelings, or thoughts can result in you experiencing considerable discomfort or strong feelings of anger, sadness, worry, fear, etc., or experiencing anxiety, depression, insomnia, etc. Xxxx Xxxxxx, LPC may challenge some of your assumptions or perceptions or propose different ways of looking at, thinking about, or handling situations, which can cause you to feel very upset, angry, depressed, challenged, or disappointed. Attempting to resolve issues that brought you to therapy in the first place, such as personal or interpersonal relationships, may result in changes that were not originally intended. Psychotherapy may result in decisions about changing behaviors, employment, substance use, schooling, housing, or relationships. Sometimes a decision that is positive for one family member is viewed quite negatively by another family member. Change will sometimes be easy and swift, but can also be slow and even frustrating. There is no guarantee that psychotherapy will yield positive or intended results. During the course of therapy, Xxxx Xxxxxx, LPC is likely to draw on various psychological approaches according, in part, to the problem that is being treated and her assessment of what will best benefit you. These approaches include, but are not limited to: Client-centered and Eclectic, Behavioral, Cognitive-Behavioral, Cognitive, Psychodynamic, Existential, Hypnotherapy, System/Family, Developmental (adult, child, family), Humanistic, EMDR (alternating bilateral stimulation for reprocessing), DBT (Dialectical Behavioral Therapy) or psychoeducational.

Appears in 1 contract

Samples: Office Policies & General Information Agreement for Psychotherapy Services and Informed Consent for Psychotherapy

TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xx. XxXxxxxxx Xxxxxxx Xxxxxx-Xxxxx between sessions, please leave a message on contact his confidential voice mail-box cell phone (000) 000-0000 and your call will be returned as soon as possible. Xx. XxXxxxxxx Xxxxxxx Xxxxxx-Xxxxx checks his messages a few times a dayduring the daytime only, unless he is out of town. If an emergency situation arises, please indicate it clearly in your message. If message and if you need to talk to someone right away, you can call Xx. Xxxxx Xxxxxxxx at (000) 000-0000Psychiatric Emergency Services, the Orange County 24-hour crisis hot line (000) 000-0000line, or the Police (911). Please do not use email or faxes for emergencies. Xx. Xxxxxxx Xxxxxx-Xxxxx does not always check his email or faxes daily. PAYMENTS & INSURANCE REIMBURSEMENT: Clients are expected to pay the standard fee of $ $250.00 for the initial therapeutic assessment session (approximately 60-75 minutes) and $225.00 per 55 45-60 minute session at the end beginning of each session or at the end of the month unless other arrangements have been made. Telephone conversations, site visits, report writing and readingreading of reports, consultation with other professionals, release of information, reading records, longer sessions, travel time, etc... . will be charged at the same rate, unless indicated and agreed upon otherwise. Please notify Xx. XxXxxxxxx Xxxxxxx Xxxxxx-Xxxxx if any problem arises problems arise during the course of therapy regarding your ability to make timely payments. Clients who carry insurance should remember that professional services are rendered and charged to the clients and not to the insurance companycompanies. Unless agreed upon differently, Xx. XxXxxxxxx Xxxxxxx Xxxxxx-Xxxxx will provide you with a copy of your receipt on a monthly basis, which you can then submit to your insurance company for reimbursement reimbursement, if you so choose. As was indicated in the section section, Health Insurance & confidentiality Confidentiality of recordsRecords, you must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk. Not all issues/conditions/problems, which are the focus of dealt with in psychotherapy, are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coverage. If your account is overdue (unpaid) and there is no written agreement on a payment plan, Xx. Xxxxxxx Xxxxxx-Xxxxx can use legal or other means (courts, collection agencies, etc.) to obtain payment. THE PROCESS OF THERAPY/EVALUATION AND SCOPE OF PRACTICE: Participation in therapy can result in a number of benefits to you, including improving interpersonal relationships and resolution of the specific concerns that led you to seek therapy. Working toward these benefits, however, requires effort on your part. Psychotherapy requires your very active involvement, honesty, and openness in order to change your thoughts, feelings, and/or behavior. Xx. Xxxxxxx Xxxxxx-Xxxxx will ask for your feedback and views on your therapy, its progress, and other aspects of the therapy and will expect you to respond openly and honestly. Sometimes more than one approach can be helpful in dealing with a certain situation. During evaluation or therapy, remembering or talking about unpleasant events, feelings, or thoughts can result in you experiencing considerable discomfort or strong feelings of anger, sadness, worry, fear, etc., or experiencing anxiety, depression, insomnia, etc. Xx. Xxxxxxx Xxxxxx-Xxxxx may challenge some of your assumptions or perceptions or propose different ways of looking at, thinking about, or handling situations, which can cause you to feel very upset, angry, depressed, challenged, or disappointed. Attempting to resolve issues that brought you to therapy in the first place, such as personal or interpersonal relationships, may result in changes that were not originally intended. Psychotherapy may result in decisions about changing behaviors, employment, substance use, schooling, housing, or relationships. Sometimes a decision that is positive for one family member is viewed quite negatively by another family member. Change will sometimes be easy and swift, but more often it will be slow and even frustrating. There is no guarantee that psychotherapy will yield positive or intended results. During the course of therapy, Xx. Xxxxxxx Xxxxxx-Xxxxx is likely to draw on various psychological approaches according, in part, to the problem that is being treated and his assessment of what will best benefit you. These approaches include, but are not limited to, behavioral, cognitive-behavioral, cognitive, psychodynamic, existential, system/family, developmental (adult, child, family), humanistic or psycho-educational. Xx. Xxxxxxx Xxxxxx-Xxxxx provides neither custody evaluation recommendation nor medication or prescription recommendation nor legal advice, as these activities do not fall within his scope of practice.

Appears in 1 contract

Samples: Informed Consent for Psychotherapy