TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xxxxxxxxx Xxxxx between sessions, please leave a message at the answering service (000) 000-0000 and your call will be returned as soon as possible. Xxxxxxxxx Xxxxx checks her messages a few times during the daytime only, unless she is out of town, and will return your call within 24 hours. If it is an emergency situation and you are in a crisis situation, and Xxxxxxxxx Xxxxx cannot be reached, you may call 911, or 24-Hour Crisis Hotlines – National 1-800-273-TALK (8255) National Suicide Prevention Lifeline, Suicide/Crisis Hotlines of Maricopa 0-000-000-0000 or 000-000-0000, or go immediately to your local hospital emergency room. Please do not use email or faxes for emergencies. Xxxxxxxxx Xxxxx may be with a client, out of the office or on vacation and may be unable to check her email or faxes daily. PAYMENTS & INSURANCE REIMBURSEMENT: Clients are expected to pay at initial appointment an intake assessment fee of $200.00 per 90 minute session (individual) or $250.00 for 90 minute session per couple or family. Clients are expected to pay the standard fee of $125.00 per 45 minutes (individual), $160.00 per 60 minutes (individual), and $185.00 per 60 minutes (couple and family) session; at the end of each session or at the end of the month unless other arrangements have been made. When clients are being seen by an Associate level therapists the cost for initial appointment, intake assessment fee of $175.00 per 90 minute session (individual) or $200.00 for 90 minute session per couple or family. Clients are expected to pay the standard fee of $100.00 per 45 minutes (individual), $130.00 per 60 minutes (individual), and $150.00 per 60 minutes (couple and family) session. Telephone conversations, site visits, writing and reading 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 Xxxxxxxxx Xxxxx if any 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 otherwise agreed upon, Xxxxxxxxx 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, if you so choose. As was indicated in the section Health Insu...
TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xx. Xxxxxxx between sessions, please leave a message at (000) 000-0000 and your call will be returned as soon as possible. Xx. Xxxxxxx checks his messages a few times during the daytime only, unless he 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 911. Please do not use email or text for emergencies. Xx. Xxxxxxx does not always check his email daily. PAYMENTS & INSURANCE REIMBURSEMENT: Clients are expected to pay the standard fee of $190.00 per 45 minute or $235.00 per initial session at the end of each session unless other arrangements have been made. Telephone conversations, site visits, writing and reading 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. Xxxxxxx if any 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 companies. Unless agreed upon differently, Xx. Xxxxxxx will provide you with a copy of your receipt upon request, 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 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 aspe...
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. PAYMENTS & INSURANCE REIMBURSEMENT: The fee or copay for service is $ for an in person, telehealth, home and telephone session. Xxxxx Xxxxxx reserves the right to periodically adjust the fee and will notify client in advance. Fees (including co-pays) are payable at time service is rendered. You can pay by check, cash, Venmo, Health Savings Account, or credit card via Square. Please note that there is an additional transaction fee of 4% for credit and debit cards. Please ask Xxxxx Xxxxxx if you wish to discuss a written agreement that specifies an alternative payment procedure. Please inform Xxxxx Xxxxxx if you wish to utilize health insurance to pay for services. If Xxxxx Xxxxxx is a contracted provider for your insurance company, she will discuss the procedure for billing your insurance. The amount of reimbursement and the amount of any co-payments or deductible depends on the requirements of you specific insurance plan. You should be aware that you are responsible for verifying and understanding the limits of your insurance coverage. Although Xxxxx Xxxxxx is happy to assist you in your efforts to seek insurance reimbursement, there is no guarantee whether your insurance will provide payment for the services provided to you. This means that you are financially responsible for any unpaid amount. Please discuss any questions or concerns that you may have about this with Xxxxx Xxxxxx. If for some reason you are unable you continue paying for therapy, you should inform Xxxxx Xxxxxx. She will help you to consider any options that may be available to you at this time. 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 mediato...
TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xx. Xxxxx between sessions, please leave a message on her confidential voicemail and your call will be returned as soon as possible. Every effort will be made to return your call the same day, with the exception of weekends and holidays. If you are difficult to reach, please leave times that you are likely available to be reached and the phone number to use. If you cannot reach Xx. Xxxxx and feel you cannot wait for her to return your call, you should call your family physician or the emergency room at the nearest hospital and ask for the psychologist or psychiatrist on call. If you are unsuccessful in reaching one of the above, and you feel it is an emergency, call 911. Please do not use e-mail, texts, or faxes for emergencies. 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. 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. 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...
TELEPHONE & EMERGENCY PROCEDURES. If you need to contact me between sessions, please leave a voicemail message at (000) 000-0000 and your call will be returned as soon as possible. I check my messages several times each day unless I am out of town. If an emergency arises, please indicate it clearly in your message. If you need to talk to someone right away you may consider calling your family physician. Initials PAYMENTS and RETAINERS: My practice is currently online via Thera-link due to Covid- 19 concerns. Payment is due upon logging in for the appointment unless other arrangements have been made. Each 50-minute session will be billed at the rate of $185.00 per session. Clients also agree to pay and maintain a retainer in the amount of $370.00. The retainer will be used to cover costs described below and may also be used to draft the Memo of Understanding at the conclusion of our process. Unused retainers shall be returned when our process is complete. PHONE & EMAILS: Phone calls requiring more than five (5) minutes and emails including any information other than scheduling an appointment shall cost the client the same hourly rate as a counseling session for the time required to print and read the emails. Dual Relationships: Confidential mediation never involves sexual or business relationships or any other dual relationship that impairs the Mediator’s objectify, judgment, and effectiveness or can be exploitative in nature. CANCELLATION: If your appointment must be canceled, a minimum of 24 hours prior notice is expected to avoid being charged for that session. If one parent cancels the session in less than 24 hours, that parent will be responsible for the entire cost of the missed session. You will also be charged if you “No Show” for your scheduled time. Retainers can be used to cover these costs. I have read the above General Information and Agreement for Confidential Mediation carefully; I understand them and agree to comply with them. Client Name (print) Date Signature
TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xx. Xxxxx between sessions, please leave a message at (000) 000-0000 and your call will be returned as soon as possible. Xx. Xxxxx checks her messages during the daytime only, unless she is out of town. If she is unavailable for an extended period of time, such as away on vacation, she will provide you with the name of a colleague to contact, if necessary. There are many times when Xx. Xxxxx is not immediately available or is in session with another client. Other circumstances, such as poor cell reception, may cause Xx. Xxxxx to be unavailable by telephone. In these instances, it is best to leave a message on her voicemail with your phone number and some good times to reach you, and she will return the call as soon as she is able. If an emergency situation arises, please indicate the nature of emergency clearly in your message, and also call 911 or go to the nearest hospital. If you need to talk to someone right away, call Psychiatric Emergency Services in Santa Xxxx at (707) 576- 818, or 911. Please do not use email, texts, or faxes for emergencies. Xx. Xxxxx does not always check her email, texts, or faxes daily. FEES, INSURANCE, and CANCELLATION POLICY: Xx. Xxxxx’x fee for clinical work is $185 per hour, and the fee for services will be established at or prior to the first meeting. The fee is collected at the time of each session. Clients are encouraged (but not required) to pay at the beginning of the session so that they can increase their attention during the session and feel undisrupted at the end.
TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xx. Xxxx between sessions, please leave a message at the answering service (000) 000-0000 and your call will be returned as soon as possible. Xx. Xxxx checks his messages a few times during the daytime only, unless he 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 Psychiatric Emergency Services. (Macomb County): (000) 000-0000 , 24-hour crisis line (Macomb County): (000) 000-0000 or the Police: 911. Please do not use email or faxes for emergencies. Xx. Xxxx does not always check his email or faxes daily. PAYMENTS & INSURANCE REIMBURSEMENT: Clients are expected to pay the standard fee of $140.00 per 45 minute or $185.00 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, writing and reading 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. Xxxx if any problems arise during the course of therapy regarding your ability to make timely payments. For those with insurance coverage, a claim describing these services will be submitted to your insurance carrier for possible reimbursement. Not all issues/conditions/problems, which are 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. Xxxx 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. Xxxx 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 un...
TELEPHONE & EMERGENCY PROCEDURES. If you need to contact your therapist, please leave a confidential voice mail message at: (000) 000-0000. A clinical representative of Ideal Living Psychology Center, Inc. may not answer the phone due to being occupied in session with another client. You therapist, however, will make every effort to return your call on the same day you leave a message, with the exceptions of those made after 5pm Mon-Friday, weekends, holidays, and vacation times. If you are difficult to reach, please inform your therapist of times when you will be available. If you are unable to reach your therapist and feel your situation is urgent, contact your family physician or the nearest emergency room and ask for the clinician/psychologist/psychiatrist on call. If the nature of the contact involves a life-threatening or emergency situation (i.e., an imminent danger to yourself or another), dial 911 immediately. If your therapist is unavailable for an extended time, she will provide you with the name of a colleague to contact, if necessary.
TELEPHONE & EMERGENCY PROCEDURES. If you need to contact me between sessions, please leave a message and your call will be returned as soon as possible. When I am out of town or otherwise unavailable, a qualified professional will cover for me. If an emergency situation arises, clearly leave your name, number and nature of the crises. If you need help immediately, you can call 911 or a 24-hour crisis line or your closest emergency room. If there is an emergency during our work together, or in the future after termination, where I become concerned about your personal safety, the possibility of you injuring someone else, or about you receiving proper psychiatric care, I will do whatever I can within the limits of the law, to prevent you from injuring yourself or others and to ensure that you receive the proper medical care. For this purpose, I may also contact the person whose name you have provided on the biographical sheet. *——————————initial Cell Phone communication and texting: Please be aware that communication by text compromises your confidentiality and is to be used for scheduling purposes only and may not be answered by me for your clinical protection. Should an emergency arise, please leave me a voicemail message and your call will be returned as soon as possible. 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 precondition of, the initiation of arbitration. The mediator shall be a neutral third party chosen by agreement of Xxxx X. Xxxxxx and client(s). The cost of such mediation , if any, shall be split equally, unless otherwise agreed. In the event that mediation is unsuccessful, any unresolved controversy related to this agreement should be submitted to and settled by binding arbitration in Los Angeles County, in accordance with the rules of the American Arbitration Association which are in effect at the time the demand for arbitration is filed. Notwithstanding the foregoing, in the event that your account is overdue (unpaid) and there is no agreement on a payment plan, Xxxx X. Xxxxxx can use legal means (court, collection agency, etc.) to obtain payment. The prevailing party in arbitration or collection proceedings shall be entitled to recover a reasonable sum for attorney's fees. In the case of arbitration, the arbitrator will determine that sum. The Process of Therapy/Evaluation: Participation in therapy can result in a number of benefits to you, incl...
TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xx. Xxxxx between sessions, please leave a message on his voice mail and your call will be returned as soon as possible. Xx. Xxxxx checks his messages throughout the day until 8 p.m. If an urgent situation arises, please indicate it clearly in your message. You may also call Xx. Xxxxx on his cell phone at (000) 000-0000. If you do not hear from Xx. Xxxxx in 10 minutes, try calling him again on his cell phone. If you. are experiencing a medical emergency, call (911). your physician or psychiatrist, or go the closest hospital emergency room. Payments & Insurance Reimbursement: Patients are expected to pay the standard fee of $100.00 per 50 minute session, deductibles and co-payments at the end of each session unless other arrangements have been made. Xx. Xxxxx will directly xxxx your insurance, EAP or other third party payor upon. , request fur no additional charge. Telephone conversations. site visits, report writing, consultation. with other professionals, release of information, longer sessions, travel time. etc. will be charged at $100.00 per hour or at a minimum of $25.00 per each 15 minutes unless indicated and agreed otherwise. These services are not covered by insurance. Please notify Xx. Xxxxx .if any problem arises during the course of therapy regarding your ability to make timely payments. Patients who carry insurance should remember that professional services are rendered and charged to the patients and not to the insurance companies. For insurances that Xx. Xxxxx is not contracted. Xx. Xxxxx will provide you with a receipt, 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. You must be given a psychiatric diagnosis in order for medical insurance to reimburse for services rendered. In most cases, marital and couples therapy are not reimbursed by insurance. If you want your spouse or partner to participate in your treatment, they may do so. In that case. The medical insurance may be billed as individual or family therapy for your session. It is your responsibility to verify the specifics of your coverage. Any uncovered amount is your responsibility.
