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 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 per 90 minute session (for individual) or $250 for 90 minute session per couple or family. Clients are expected to pay the standard fee of $120.00 per 45 minutes (individual), 150 per 60 for (individual) or $150.00 per 45 minutes for (couple) and 175 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. 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 companies. Unless agreed upon differently, 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 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...
TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Xxxx between sessions, please leave a message on her answering machine (000) 000-0000, and your call will be returned as soon as possible. Xxxx checks her messages regularly Monday through Friday and less frequently on week-ends. If an emergency situation arises, please indicate it clearly in your message. If you need to talk to someone right away, you can call the 24-hour crisis line (Psychiatric Emergency Services) at (000) 000-0000, or contact Emergency services at 911. PAYMENTS & INSURANCE REIMBURSEMENT: Clients are expected to pay the standard fee of $125 per 50-minute session at the beginning of each session unless other arrangements have been made. Telephone conversations, site visits, report writing and reading, 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 otherwise. Please notify Xxxx if any problem arises during the course of therapy regarding your ability to make timely payments. If you would like, Xxxx will provide you with a Superbill on a monthly basis, which you can then Xxxx Xxxxx Xxxxxx, LMFT (000) 000-0000 xxx.xxxxxxxxxxxxxxxxxxxxxxx.xxx submit to your insurance company for reimbursement if you so choose. Not all issues/ conditions/problems, which are the focus of psychotherapy, are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coverage. If I have an agreement to bill through your insurance company, I will make every reasonable effort to collect payment from your insurance company. However, you are ultimately responsible for all payments. You will be responsible for any services not reimbursed by your insurance company payment is expected in a timely manner.
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. PAYMENTS & INSURANCE REIMBURSEMENT: 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 is billed at $185.00 due at the time of the meeting. If your insurance will cover this type of counseling, I will supply you with an insurance billing form that you can submit to your insurance provider for direct reimbursement. Yes, I will need an insurance xxxx for reimbursement PHONE, EMAILS AND LETTERS: Phone calls requiring more than five (5) minutes and emails including any information other than scheduling an appointment shall cost the same hourly rate as a counseling session for the time required to print and read the emails. REFERRALS: If in the course of our working together I determine that I cannot assist you to the full degree you are in need of, I will refer you to another professional(s) who would likely be more able to assist you in your efforts to produce change and growth in your life. DUAL RELATIONSHIPS: Therapy never involves sexual or business relationships or any other dual relationship that impairs the therapist’s objectivity, clinical judgment, therapeutic effectiveness or can be exploitative in nature. CANCELLATION: Appointments are arranged so that we share a consistent, ongoing weekly or biweekly scheduled time together. If your appointment must be canceled, a minimum of 24 hours prior notice is expected to avoid being charged for that session. You will also be charged if you “No Show” for your scheduled time. Initials MY AGREEMENT TO YOU: I agree to assist you in gaining awareness and understanding of the obstacles you face, and to help you gain new skills to make healthy choices in your life, however, this in no way guarantees that the changes you would like to have happen will occur. I have read the above Office Policies and General Information Agreement 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 voicemail 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 or have not set up your voicemail, 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 to ask for the clinician/psychologist/psychiatrist on call. If the nature of the contact involves a life-threatening emergency (i.e., an imminent danger to yourself or another person), 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 Renewing Hope between sessions, please leave a message with your therapist and your call will be returned as soon as possible. Renewing Hope therapists check messages a few times during the daytime. If an emergency situation arises, indicate it clearly in your message and if you need to talk to someone right away call the 24-hour crisis line: (000) 000-0000 or call 911. Please do not use email or faxes for emergencies. Renewing Hope does not always check email or faxes daily. 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 pre-condition of, the initiation of arbitration. The mediator shall be a neutral third party chosen by agreement of 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, any unresolved controversy related to this agreement should be submitted to and settled by binding arbitration in Nebraska 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, Renewing Hope 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 as and for attorney's fees. In the case of arbitration, the arbitrator will determine that sum. 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. 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 f...
TELEPHONE & EMERGENCY PROCEDURES. If you need to contact Dr. Xxx between sessions, please leave a message at (000) 000-0000 and your call will be returned as soon as possible. Dr. Xxx checks his messages a few times a day (but never during the night time), unless he is out of town. Dr. Xxx checks the messages less frequently on weekends and holidays. If an emergency situation arises, please indicate it clearly in your message. If you need to talk to someone right away, you can call the 24-hour crisis line (000) 000-0000 or the Police at: 9-1-1. PAYMENTS & INSURANCE REIMBURSEMENT: Clients are expected to pay the standard Fee of $250 per 50 minutes session at the beginning of each session unless other arrangements have been made. Telephone conversations, site visits, report writing and reading, 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 otherwise. Please notify Dr. Xxx if any problem arises 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, Dr. Xxx 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 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/problem, which are the focus of psychotherapy, are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coverage. THE PROCESS OF THERAPY/EVALUATION: Participation in therapy can result in a number of benefits to you, including improving interpersonal relationship and resolution of the specific concerns that led you to seek therapy. Working toward these benefits; however, requires effort on your part. Psychotherapy requires a very active involvement, honesty, and openness in order to change your thoughts, feelings and/or behavior. Your therapist 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, rememberi...
