TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xxxxx Xxxxxx between sessions, please leave a message on her confidential voice mail at (000) 000-0000 and your call will be returned as soon as possible. Xxxxx Xxxxxx checks her messages a few times during the daytime only, unless she is out of town. If an emergency situation arises, indicate it clearly in your message and if you need to talk to someone right away, call the Police: 911. Please do not use email or faxes for emergencies. DELINQUENT ACCOUNT POLICY: If your account is overdue (unpaid) and there is no written agreement on a payment plan, Xxxxx Xxxxxx can use legal or other means (courts, collection agencies, etc.) to obtain payment. MEDIATION & ARBITRATION: All disputes arising out of, or in relation to, this agreement to provide psychotherapy services shall preferably first be referred to mediation before the initiation of arbitration or litigation. The mediator shall be a neutral third party chosen by agreement of Xxxxx Xxxxxx and the client(s). The cost of such mediation, if any, shall be split equally, unless otherwise agreed upon. In the event that mediation is unsuccessful or not an agreed-upon option, any unresolved controversy related to this agreement should preferably be submitted to and settled by binding arbitration, in accordance with the rules of the American Arbitration Association which are in effect at the time the request for arbitration is filed. Please, note that neither mediation nor arbitration is mandatory. In the PATIENT LITIGATION: Xxxxx Xxxxxx will not voluntarily participate in any litigation, or custody dispute in which client and another individual, or entity, are parties. Xxxxx Xxxxxx has a policy of not communicating with client’s attorney and will not write or sign letters, reports, declarations, or affidavits be used in client’s legal matter. Xxxxx Xxxxxx will not provide records or testimony to be used in client’s legal matter. There are occasions where Xxxxx Xxxxxx will make an exception and charge the fee of THE PROCESS OF THERAPY/EVALUATION AND SCOPE OF PRACTICE: Participation in
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Samples: Office Policies & General Information Agreement for Psychotherapy Services, Informed Consent for Psychotherapy, Office Policies & General Information Agreement for Psychotherapy Services
TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xxxxx Xxxxxx Renewing Hope between sessions, please leave a message on her confidential voice mail at (000) 000-0000 with your therapist and your call will be returned as soon as possible. Xxxxx Xxxxxx checks her Renewing Hope therapists check messages a few times during the daytime only, unless she is out of towndaytime. If an emergency situation arises, indicate it clearly in your message and if you need to talk to someone right away, away call the Police24-hour crisis line: (000) 000-0000 or call 911. Please do not use email or faxes for emergencies. DELINQUENT ACCOUNT POLICY: If your account is overdue (unpaid) and there is no written agreement on a payment plan, Xxxxx Xxxxxx can use legal Renewing Hope does not always check email or other means (courts, collection agencies, etc.) to obtain paymentfaxes daily. MEDIATION & ARBITRATION: All disputes arising out of, or in relation to, this agreement to provide psychotherapy services shall preferably first be referred to mediation before mediation, before, and as a pre-condition of, the initiation of arbitration or litigationarbitration. The mediator shall be a neutral third party chosen by agreement of Xxxxx Xxxxxx Renewing Hope and the client(s). The cost of such mediation, if any, shall be split equally, unless otherwise agreed upon. In the event that mediation is unsuccessful or not an agreed-upon optionunsuccessful, any unresolved controversy related to this agreement should preferably be submitted to and settled by binding arbitration, arbitration in Nebraska in accordance with the rules of the American Arbitration Association which are in effect at the time the request demand for arbitration is filed. PleaseNotwithstanding the foregoing, note in the event that neither mediation nor your account is overdue (unpaid) and there is no agreement on a payment plan, Renewing Hope can use legal means (court, collection agency, etc.) to obtain payment. The prevailing party in arbitration is mandatoryor collection proceedings shall be entitled to recover a reasonable sum as and for attorney's fees. In the PATIENT LITIGATION: Xxxxx Xxxxxx case of arbitration, the arbitrator will not voluntarily participate in any litigation, or custody dispute in which client and another individual, or entity, are partiesdetermine that sum. Xxxxx Xxxxxx has a policy of not communicating with client’s attorney and will not write or sign letters, reports, declarations, or affidavits be used in client’s legal matter. Xxxxx Xxxxxx will not provide records or testimony to be used in client’s legal matter. There are occasions where Xxxxx Xxxxxx will make an exception and charge the fee of THE PROCESS OF THERAPY/EVALUATION AND SCOPE OF PRACTICE: Participation inin 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. You will be asked for 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. You may be challenged on 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.
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TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xxxxx Xxxxxx Xxxxxxx Xxxxxxx between sessions, please leave a message on her confidential voice mail at (000) 000-0000 and your call will be returned as soon as possible. Xxxxx Xxxxxx Xxxxxxx Xxxxxxx checks her messages a few times during the daytime only, unless she is out of town. If an emergency situation arises, indicate it clearly in your message and if you need to talk to someone right away, away call the 24-hour crisis line (San Diego): 0-000-000-0000 or the Police: 911. Please do not use email email, text messages or faxes for emergencies. DELINQUENT ACCOUNT POLICYXxxxxxx Xxxxxxx does not always check her email or faxes daily. Payments & Insurance Reimbursement: If your account is overdue (unpaid) Clients are expected to pay the agreed upon fee at each session unless other arrangements have been made. Telephone conversations, site visits, writing and there is no written agreement on a payment planreading of reports, Xxxxx Xxxxxx can use legal or consultation with other means (courtsprofessionals, collection agenciesrelease of information, reading records, longer sessions, travel time, etc.) . will be charged at the same rate, unless indicated and agreed upon otherwise. Please notify Xxxxxxx Xxxxxxx if any problems arise during the course of therapy regarding your ability to obtain paymentmake timely payments. MEDIATION Mediation & ARBITRATIONArbitration: All disputes arising out of, or in relation to, this agreement to provide psychotherapy psychotherapy, psychoeducational, consulting or assessment services shall preferably first be referred to mediation before mediation, before, and as a pre-condition of, the initiation of arbitration or litigationarbitration. The mediator shall be a neutral third party chosen by agreement of Xxxxx Xxxxxx Xxxxxxx Xxxxxxx and the client(s). The cost of such mediation, if any, shall be split equally, unless otherwise agreed upon. In the event that mediation is unsuccessful or not an agreed-upon optionunsuccessful, any unresolved controversy related to this agreement should preferably be submitted to and settled by binding arbitrationarbitration in San Diego County, CA in accordance with the rules of the American Arbitration Association which are in effect at the time the request demand for arbitration is filed. PleaseNotwithstanding the foregoing, note in the event that neither mediation nor your account is overdue (unpaid) and there is no agreement on a payment plan, Xxxxxxx Xxxxxxx can use legal means (court, collection agency, etc.) to obtain payment. The prevailing party in arbitration is mandatoryor collection proceedings shall be entitled to recover a reasonable sum as and for attorney's fees. In the PATIENT LITIGATION: Xxxxx Xxxxxx case of arbitration, the arbitrator will not voluntarily participate in any litigation, or custody dispute in which client determine that sum. The Process of Therapy/Evaluation and another individual, or entity, are parties. Xxxxx Xxxxxx has a policy Scope of not communicating with client’s attorney and will not write or sign letters, reports, declarations, or affidavits be used in client’s legal matter. Xxxxx Xxxxxx will not provide records or testimony to be used in client’s legal matter. There are occasions where Xxxxx Xxxxxx will make an exception and charge the fee of THE PROCESS OF THERAPY/EVALUATION AND SCOPE OF PRACTICEPractice: Participation inin 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.
Appears in 1 contract
Samples: Agreement for Psychotherapy, Psychoeducational, Consulting, and Assessment Services
TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xxxxx Xxxxxx me between sessionssessions with an emergency, please text me (preferred) or leave a message on her confidential with my voice mail at (000) 000-0000 and your call message will be returned as soon as possible. Xxxxx Xxxxxx checks her I do my best to check my messages frequently, however, as I am not always available, please contact the crisis hotline or 911 in the case of a few times during the daytime only, unless she is out of towncrisis or emergency. If an emergency situation arises, indicate it clearly in your message and if you need to talk to someone right awaygain immediate assistance, please call the Police: 911. Please do not use email or faxes for emergenciesThe National Suicide Prevention Lifeline can be contacted at 1-800- 273-8255. DELINQUENT ACCOUNT POLICY: If your account is overdue Clients are expected to pay the agreed-upon fee at the end of each session unless other arrangements have been made. Site visits, report writing, in-person consultation (unpaidas requested by you) and there is no written agreement on a payment planwith other professionals, Xxxxx Xxxxxx can use legal or other means (courtslonger sessions, collection agenciestravel time, etc.. will be charged at the same rate, unless indicated and agreed otherwise. Please notify me if any problem arises during the course of therapy regarding your ability to make timely payments. For any last-minute cancellations (less than 24 hours’ notice) to obtain or no-show appointments, you are responsible for the full payment. MEDIATION & ARBITRATION: Please know that you are always encouraged to explore other possibly more affordable services with your carrier such as through a Preferred Provider Option (PPO) or by seeing a clinician who is contracted with your insurance company. All disputes arising out of, of or in relation to, to this agreement to provide psychotherapy services shall preferably first be referred to mediation before mediation, before, and as a pre-condition of, the initiation of arbitration or litigationarbitration. The mediator shall be a neutral third party chosen by agreement of Xxxxx Xxxxxx and the client(s)between us. The cost of such mediation, if any, shall be split equally, unless otherwise agreed uponagreed. In the event that mediation is unsuccessful or not an agreed-upon optionunsuccessful, any unresolved controversy related to this agreement should preferably be submitted to and settled by binding arbitrationarbitration in Yolo County, CA in accordance with the rules of the American Arbitration Association which that are in effect at the time the request demand for arbitration is filed. PleaseNotwithstanding the foregoing, note in the event that neither mediation nor your account is overdue and there is no foreseeable potential agreement on a payment plan, I may use legal means (court, collection agency, etc.) to obtain payment. The prevailing party in arbitration is mandatoryor collection proceedings shall be entitled to recover a reasonable sum for attorneys’ fees. In the PATIENT LITIGATION: Xxxxx Xxxxxx case of arbitration, the arbitrator will not voluntarily participate determine that sum. I will make every effort beforehand, however, to work with you to find a supportive, mutually-respectful arrangement for payment well before arbitration services are employed. Participation in any litigationtherapy 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 or your child’s/teen’s part. Psychotherapy requires your very active involvement, honesty, and openness in order to change your thoughts, feelings and/or behavior. I will ask for your feedback and views on our work together, its progress, and other aspects of the therapy and will encourage you to respond openly and honestly. During the course of therapy, I am likely to draw on various psychological approaches to address the problem that is being treated and my assessment of what will best benefit you. These approaches may include those from the psychodynamic, cognitive-behavioral, system/family, developmental (adult, child, family), or custody dispute psycho-educational perspectives. Sometimes more than one approach can be helpful in which client and another individualdealing with a certain situation. Attempting to resolve issues that brought you to therapy in the first place may result in changes that were not originally intended. For example, during the initial phase of the evaluation or throughout the course of ongoing therapy, the process of reflecting on or talking about unpleasant events, feelings, or entitythoughts could elicit considerable discomfort including feelings of anger, are partiessadness, worry, fear, anxiety, depression, etc. Xxxxx Xxxxxx has a policy Additionally, as I challenge some of not communicating with client’s attorney and will not write your assumptions or sign lettersperceptions or propose different ways of looking at, reports, declarationsthinking about, or affidavits handling situations, this could potentially cause you to feel upset, saddened, anxious and/or disappointed. Psychotherapy may also affect your decision-making process and result in the changing of behaviors, employment, substance use, schooling, housing, or relationships. Sometimes a decision that is positive for one family member is viewed negatively by another family member. Change will sometimes be used easy and swift, but more often, it will be slow and at times even frustrating. Lastly, it’s important to remember that there is no absolute guarantee that psychotherapy will yield positive or intended results. Please know, however, that I will do my very best to try to make our work together a meaningful and transformative experience for you. Your appointment will last 50 minutes. If I am providing services to your young child, please do not drop the client off in client’s legal matterthe waiting room without checking in with me first. Xxxxx Xxxxxx will I ask that you please be prompt in picking up your child after the appointment as I often have sessions scheduled each hour and would not provide records want to risk leaving your child in the lobby unsupervised, unless specific arrangements are made in advance with you. I routinely offer clients a lollipop and cup of tea or testimony hot chocolate at the beginning of sessions. If you or your child/teen has any dietary restrictions concerning any of these items, please let me know. By signing this form, you are agreeing to be used in client’s legal matter. There are occasions where Xxxxx Xxxxxx will make an exception and charge not hold me legally responsible for any incidental liquid xxxxx, unanticipated allergic reactions and/or related incidents of safety concern that may result from the fee consumption of THE PROCESS OF THERAPY/EVALUATION AND SCOPE OF PRACTICE: Participation inthese items.
Appears in 1 contract
Samples: Office Policies & General Information Agreement for Psychotherapy Services