I would like to take this opportunity to welcome you to my practice. My goal as your therapist is to form a collaborative relationship with you to assist you in finding healthy solutions to your problems.
This statement contains information regarding my office policies. Please read them and if you have any questions, discuss them with me. Your signature at the bottom of this sheet signifies that you have read, understand and agree to abide by these policies.
Each session is approximately 45-50 minutes in length. Your appointment time is reserved especially for you. Please respect that there may be times when other clients are on a waiting list to be seen. If you must cancel, please notify the office as soon as possible. If an appointment is missed or it is cancelled with less than 24 hours notice, you will be charged $50. Please be aware that your insurance company cannot be billed for fees associated with missed or canceled appointments.
I am available to return routine and urgent calls within 24 hours. There is always a 24-hour voicemail and answering service seven days a week, so messages can be left at any time. My emergency number is 404-918-9937. Please respect that this number is for emergencies only. If emergency mental health services are needed and I am not available to contact you immediately, call the emergency mental health number in your county, go directly to the closest emergency room or call 911.
If you have coverage for behavioral healthcare under an insurance plan, you are responsible for obtaining initial authorization for treatment from your insurance carrier. I will bill your insurance, however, you are responsible for co-payment amounts and deductibles as set for the by your benefit plan. Missed appointments, disability evaluations, court ordered evaluations, completion of forms for attorneys or employees, court appearances, copies of records, letters, or any other types of reports are not covered by your insurance and the charges associated with them are your responsibility. Please understand that there may be times when your insurance company may fail to pay the claims that are submitted. Our office will make every attempt we can to obtain payment, however if your insurance payment is unable to pay, we will have to bill you for the unpaid balance.
There may be certain circumstances in which a client may not be covered by insurance or wish to pay privately due to concerns about having to release confidential information to there insurance companies or simply due to the fact that certain services are not covered by their insurance plan. I do offer a variety of service packages that can be custom designed to fit your needs if you choose to pay out of pocket.
If you choose to pay out of pocket, 45-50 minute counseling sessions are $90. Hypnotherapy sessions are $100 per hour (please be aware that some insurance companies will pay for hypnotherapy). Relationship Coaching sessions began at $90 per session. Please be aware that several discounted packages are also available. Please ask me for a menu of services and discuss with me how a custom designed optimum therapy package might be developed to meet your needs. All fees are to be paid at the time of service.
Some people may find that online and phone counseling may be more convenient for their schedule, therefore I also offer these services. Scheduled phone and online sessions are prorated according to the normal per session fees.
*Paperwork charges for disability evaluations, court ordered evaluations, completion of forms for attorneys or employers, or any other type of reports requested by you or an outside source is $50 for complex paperwork and $20 for simple paperwork.
*If a check is returned, there will be a $25 return check fee charged.
*Court appearance charges start at $500 and increase depending on time spent in court and client scheduling time lost.
*There is a charge of $15 to copy records, plus postage if applicable.
People terminate counseling for various reasons. Sometimes termination is premature of goals being met, while at times counseling is terminated because goals have been accomplished. I want to ensure you that it is my policy to support all termination, for whatever reason.
Termination (ending therapy) is an important part of the treatment process. It is best this be a joint decision so progress can be reviewed and expectations for the future can be discussed. Although it is my goal to work with you until your treatment goals have been completed, there will be times when therapy will have to be terminated prematurely. If I cannot provide appropriate therapy for your treatment needs, if treatment goals that are mutually agreeable cannot be developed, if financial commitments are not honored, if you are not benefiting from therapy or if the therapy environment becomes unsafe, if there is repeated non-compliance with appointments, the therapeutic relationship will be terminated.
Any nonvoluntary termination will be accompanied by an appropriate referral for mental health services. A case will be identified as voluntarily closed after mutual discussion between therapist and client(s) or if there has been no contact for 60 days. |
