Therapist Communications. Your therapist may need to communicate with you by telephone, e-mail, mail, or other means. Please indicate your preference by so indicating on the Intake Form you have filled out. 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. Initials: Additional Charges: Your therapist is not agreeable to appearing in court or providing testimony by way of deposition or declaration. Specifically, your therapist is client’s treating mental health care professional and will not testify in an expert capacity or as an advocate in any legal proceeding client may be or become involved in. However, in the event your therapist is compelled or ordered by the court to provide records or testimony, you hereby agree to pay your therapist for the following: • If copies of any of your records must be made, pursuant to your authorization or order of the court, such copies shall be made at the cost of $.25 per page and preparation of said copies will be billed at $200.00 per hour. • In the event your therapist is subpoenaed to testify in court or deposition or requested to produce records or provide a summary of treatment, your therapist will be paid $300.00 per hour for her preparation time, travel time from portal to portal, wait time, time spent providing testimony as well as time spent reviewing the deposition transcript. • If these fees are not paid by the attorneys involved in your case, you, the client, will be responsible to pay the fees within 30 days of the provided invoice. If these fees have not been collected within 30 days, your therapist retains the right to collect these fees in Small Claims Court. Initials:
Therapist Communications. Your therapist may need to communicate with you by telephone, mail or other means. Please indicate your preference by so indicating on the New Client Form you have filled out. 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.
Therapist Communications. 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 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: ( ) _
Therapist Communications. 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 call me at 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 About the Therapy Process 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. She believes that therapist and 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.
Therapist Communications. Therapist may need to communicate with Client by telephone, mail or other means. Please indicate Client preference by checking one of the choices below. Please be sure to inform Therapist if you do not wish to be contacted at a particular time or place, or by a particular means. Therapist may call Client at Client home. Home number is: Therapist may call Client on Client cell phone. Cell phone number is: Therapist may call Client at work. Work phone number is: Therapist may send mail to Client at Client home address: Therapist may send mail to Client at Client work address: Therapist may communicate with Client by email. Client email address is:
