Office Policies and Procedures
The following guidelines are necessary to ensure professional and therapeutic care. Please read the following carefully and ask for specifications about any element you do not fully understand.
Confidentiality
The laws and standards of the counseling profession require that I keep treatment records. All information disclosed within sessions and the written records pertaining to those sessions are confidential and may not be revealed to anyone without your written permission, except where law requires disclosure. Law, in the following circumstances, may require disclosure:
- Where there is reasonable suspicion of child or elder abuse or neglect
- Where a client presents a danger to him/herself or to another person
- A client is gravely disabled
The intent of such requirements is that a therapist has a legal and ethical responsibility to take action to protect endangered individuals from harm when the therapist’s judgement indicates that danger exists. Regarding the above circumstances, only information necessary to expedite the resolution of the emergency is revealed. Therefore, if there is an emergency during our work together or the possibility of you injuring yourself or someone else, I am obligated to do whatever I can within the limits of the law to assure your safety and the safety of others. For this purpose, I may contact the person you have listed as an emergency contact, notify the potential victim, contact the police or seek hospitalization when necessary.
Client Rights
HIPAA provides you with several rights with regard to your PHI record and disclosures of protected health information. These rights include:
- The right to request that I amend your record
- The right to request restrictions on what information from your PHI record is disclosed to others
- The right to request an accounting of most disclosures of PHI that you have neither consented to nor authorized
- The right to determine the location to which protected information disclosures are sent
- The right to have any complaints you make about my p9olicies and procedures documented in your record
- The right to a paper copy of this agreement, and my privacy policies and procedures
- The right to revoke your consent to send information to your insurance company effective on the date I receive the revocation in writing.
As a client, you have the right to review or receive a summary of your psychotherapy record, except in limited legal or emergency circumstances. In such circumstances, I may provide you with a summary of your records, or may provide the summary to an appropriate mental health professional of your choice. Upon your authorization, I will release information to any agency/person you specify unless I assess that releasing information will be harmful to you in any way. You will be charged an appropriate fee for any professional time spent in responding to an information request regarding you or your treatment.
Availability and Emergency Procedures
If you need to contact me between sessions, please leave a message on my voicemail. I check my messages several times a day and will return your call as soon as I am available. Calls received after 5 pm on Friday may not be returned until Monday. If you need to talk to someone right away, you can call Emergency Services at (540) 373-6876, Snowden at (540) 373-3900, the police at 911 or got to the nearest emergency room. If an emergency situation arises in which you are being harmed or are in danger of harming yourself or someone else, please call 911.
I will be away from the office at various times throughout the year. During these times, if you would need to see a mental health professional, I will provide you with the name of a qualified therapist that you can contact.
Payment and Billing Information
Clients who carry insurance for which I am not a provider are expected to pay the fee of $145 for a 50 minute intake session at the beginning of each session. It is your responsibility to obtain the appropriate reimbursement form from your insurance company if you choose to do so. Insurance companies do not reimburse all issues/conditions/problems that are the focus of treatment. It is your responsibility to verify the specifics of your coverage.
Telephone conversations, site visits, report writing and reading, consultation with other professionals, release of information, release of records, longer sessions, travel time, etc. will be charged at the rate of $145 per 50-minutes unless indicated and agreed otherwise.
Please notify me if any problem arises during the course of therapy regarding your ability to make timely payments. It is important to evaluate your financial resources in terms of covering treatment fees. If you should encounter financial difficulties that interfere with your ability to pay for services rendered, it is important to notify me as soon as possible. I will make reasonable effort to find a referral whose fees are more affordable to you. If your account is overdue (unpaid) and there is no agreement on a payment plan, I can use legal means (court, collection agency, etc.) to obtain payment. Should your account be referred for collection, you will be responsible for all of the collection cost including attorney’s fees and court costs. There will be a $50 fee for returned checks from the bank.
Cancellation
Since the scheduling of an appointment involves the reservation of time especially for you, the full session fee will be charged for sessions missed without 24-business hour notice of cancellation. Payment information kept on file will be used unless otherwise indicated. I value the importance of keeping scheduled appointments in order to maintain the movement of the therapeutic process. Therefore, if I need to cancel an appointment with you, I will only do so when it is important and will do my best to reschedule it within the same week.
Other Guidelines
- You have the right to be treated, and the obligation to treat staff therapist, respectfully and non-abusively. Failure to do could result in discharge and termination.
- All future sessions after a missed appointment or late cancellation will await payment for the missed session.
- The misuse of your right to call me (and expect a prompt answer) could result in discharge and termination.
- If you are receiving services from another mental health service provider, I reserve the right to determine whether or not providing services in conjunction with them, is in your best interest and ensures your well-being.
If you're a new client, please complete the following forms and bring them to your first therapy session.
If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:
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