All the information below will be discussed in further detail during intake.
A copy of these policies is available online, 24 hours a day, 7 days a week for you to review.
If you would like a paper copy, one can be provided to you as well, if requested.
APPOINTMENTS AND CANCELLATIONS
Please remember to cancel or reschedule 24 hours in advance. You will be responsible for a full service fee if appointment is cancelled less than 24 hours in advance or if you do not show to your scheduled appointment. The standard meeting time for therapy is 45 minutes. Cancellations and re-scheduled sessions will be subject to charge if NOT RECEIVED AT LEAST 24 HOURS IN ADVANCE. This is necessary because your time and my time is valuable and I make every effort to be available for my clients. If you are late for a session, you may lose some of that session time.
SOCIAL MEDIA AND TELECOMMUNICATION
Due to the importance of your confidentiality and privacy, and the importance of minimizing dual relationships, I do not accept friend or contact requests from current or former clients on any of my personal social networking accounts (Facebook, LinkedIn, etc). I believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. I do not disclose any confidential treatment information through social media, nor do I provide professional counseling services through social media.
ELECTRONIC COMMUNICATION
I cannot ensure the confidentiality of any form of communication through electronic media, including text messages. If you prefer to communicate via email or text messaging for issues regarding scheduling or cancellations, it is at your own risk. While I try to return messages in a timely manner, I cannot guarantee immediate response and request that you do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies.
Services by electronic means, including but not limited to telephone communication, the Internet, facsimile machines, and e-mail is considered telemedicine by the State of California. Under the California Telemedicine Act of 1996, telemedicine is broadly defined as the use of information technology to deliver medical services and information from one location to another. If you and your therapist choose to use information technology for some or all of your treatment, you need to understand that:
(1) You retain the option to withhold or withdraw consent at any time without affecting the right to future care or treatment or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled.
(2) All existing confidentiality protections are equally applicable.
(3) Your access to all medical information transmitted during a telemedicine consultation is guaranteed, and copies of this information are available for a reasonable fee.
(4) Dissemination of any of your identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without your consent.
(5) There are potential risks, consequences, and benefits of telemedicine. Potential benefits include, but are not limited to, improved communication capabilities, providing convenient access to up-to-date information, consultations, support, reduced costs, improved quality, change in the conditions of practice, improved access to therapy, better continuity of care, and reduction of lost work time and travel costs. Effective therapy is often facilitated when the therapist gathers within a session or a series of sessions, a multitude of observations, information, and experiences about the client. Therapists may make clinical assessments, diagnosis, and interventions based not only on direct verbal or auditory communications, written reports, and third person consultations, but also from direct visual and olfactory observations, information, and experiences. When using information technology in therapy services, potential risks include, but are not limited to, the therapist's inability to make visual and olfactory observations of clinically or therapeutically potentially relevant issues such as: your physical condition including deformities, apparent height and weight, body type, attractiveness relative to social and cultural norms or standards, gait and motor coordination, posture, work speed, any noteworthy mannerism or gestures, physical or medical conditions including bruises or injuries, basic grooming and hygiene including appropriateness of dress, eye contact (including any changes in the previously listed issues), sex, chronological and apparent age, ethnicity, facial and body language, and congruence of language and facial or bodily expression. Potential consequences thus include the therapist not being aware of what he or she would consider important information, that you may not recognize as significant to present verbally the therapist.
PROFESSIONAL BOUNDARIES
It is likely that we may see each other in public from time to time. Please keep in mind that I will not initiate contact with you if I see you in the community. This is to protect your confidentiality and privacy. You are welcome to approach me, say “hello,” or acknowledge me if you would like to, just know that by doing so it could compromise your confidentiality in some ways.
MINORS & THERAPEUTIC SERVICES
If you are a minor, your legal guardian may be legally entitled to some information about your therapy services. I will discuss with you and your legal guardian what information is appropriate for them to receive and which issues are more appropriately kept confidential. I reserve the right to request legal documentation and information about custodial arrangements before continuing the treatment of any minor (persons under the age of 18). These requests may include, but are not limited to, court appointed custody arrangements, guardianship letters, restraining orders, and/or adoption paperwork.
PATIENT LITIGATION & TREATMENT SUMMARIES
I will not voluntarily participate in any litigation or custody dispute in which my clients are a part of, and I do not make recommendations regarding custody cases, court cases, or legal matters. I generally do not communicate with my client’s attorneys and will generally not write or sign letters, reports, declarations, or affidavits to be used in client’s legal matter. Should this provider or treatment records be subpoenaed, or ordered by a court of law, to appear as a witness, you agree to reimburse me for any time spent for preparation, travel, or other time in which I have made myself available for such an appearance at a rate of $300 per hour. Subpoena requests must be made at least 2 weeks in advance. All fees must be paid in full prior to the court appearance.
THERAPIST-PATIENT PRIVILEGE
The information disclosed by clients ("patients"), as well as any records created, is subject to therapist-patient privilege. The therapist-patient privilege results from the special relationship between “Therapist” and “Patient” in the eyes of the law. Typically, the client is the holder of the therapist-patient privilege. If therapist received a subpoena for records, deposition testimony, or testimony in a court of law, the therapist will assert the therapist-patient privilege on the client’s behalf until instructed, in writing, to do otherwise by client or client’s representative. Clients should be aware that they might be waiving the therapist-patient privilege if they make their mental or emotional state an issue in a legal proceeding. Clients should address any concerns they might have regarding the therapist-patient privilege with their attorney.
SAFETY PLANNING
In the event that you are feeling unsafe or require immediate medical or psychiatric assistance, I will provide a safety assessment and ask you to voluntarily agree to a safety plan. If in my clinical opinion, you are at imminent risk to yourself or others and you are unwilling to agree to a safety plan, I will legally and ethically follow mandated reporting procedures and contact the appropriate authorities to ensure safety for yourself and others. This could include, but is not limited to, contacting emergency contacts, local authorities, your specified primary care doctor, Child Protective Services (CPS), Adult Protective Services (APS), etc. If over time, I decide that it is no longer ethically appropriate to continue treatment due to safety concerns, I will terminate the therapeutic relationship and provide a referral to a higher level or more appropriate level of care.
FEE AGREEMENT & INSURANCE POLICY
The usual and customary fee and/or insurance options will be discussed with you. You will be notified of any fee adjustment in advance. In addition, this fee may be adjusted by contract with insurance companies, managed care organizations, or other third-party payers, or through an agreement between us. From time-to-time, I may engage in telephone contact with third parties at your request and advance written authorization. You are responsible for payment of the agreed upon fee (on a pro rata basis) for any telephone calls lasting longer than fifteen minutes. Clients are expected to pay for services at the time services are rendered. Cash, major credit cards, and checks are accepted at this time. For billing purposes, we require that a credit card remain on file for you and we reserve the right to charge your credit card for late-cancelled or missed appointments (please refer to the above cancellation policy). I use an Electronic Health Record that is password protected, HIPAA compliant, and all credit card information is kept confidential. If at any time your credit card information changes or is otherwise deemed invalid, another credit card will need to be provided to continue services.
GOOD FAITH ESTIMATE & NO SURPRISES ACT
Under the law, health care providers need to give clients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including therapy services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including therapy services. You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service, or at any time during treatment. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, or how to dispute a bill, see your Estimate, or visit www.cms.gov/nosurprises.
INSURANCE
At this time, I do not accept insurances and all services are out-of-pocket.
LETTER WRITING & TREATMENT SUMMARY REQUESTS
In some instances, a treatment summary may suffice for certain requested situations. I may provide treatment summaries, as requested and on an individual basis; fees will be discussed prior to completing treatment summaries for clients. Other such evaluation notes may be requested, as needed. Please be aware that requests must be made at least 2 weeks in advance, and the fee for each letter is $75.00. Please speak with me for further information or questions. At this time, I do not provide clients with letters regarding emotional support animals (ESA) for any reason.
PROVIDER AVAILABILITY & SAFETY RESOURCES
Please keep in mind that my availability is limited to day time office hours, Tuesday through Thursday, and often times I am unable to answer the phone due to meeting with clients. You are allowed to leave a confidential voice message at any time, my voicemail box is password protected and only accessible to me. I will make every effort to return calls within 24 hours (or by the next business day) but cannot guarantee the calls will be returned immediately. I am unable to provide 24-hour crisis services and you will be given a list of local, state and national resources, at time of intake. In the event that you are feeling unsafe or require immediate medical or psychiatric assistance, please call 911, or go to the nearest emergency room.
TERMINATION AND CONTINUATION OF CARE
Ending relationships, even therapeutic ones, can be difficult. Therefore, it is important to have a termination process in order to achieve some closure. Termination will be discussed during intake. The appropriate length of the termination depends on the length and intensity of the treatment. I may terminate treatment after appropriate discussion with you if one of the following apply: the therapy is not being effectively used, there are safety concerns that require a higher level of care, the treatment issues are beyond the scope of my practice, or if you are in default on payment. I reserve the right to terminate treatment due to personal and professional reasons or any unforeseen circumstances that may arise. I will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. If therapy is terminated for any reason or you request another therapist, I will provide you with a list of qualified therapists to treat you and local community resources. You may also choose someone on your own or from another referral source. In the event of my termination of practice, incapacitation, or untimely death, your records will be taken over and contact will be made by a qualified mental health professional whom I have selected.
Should you fail to schedule an appointment for two consecutive weeks, unless other arrangements have been made in advance,
for legal and ethical reasons,
I must consider the professional relationship discontinued.
After two weeks, you will be sent a courtesy letter confirming your termination at this time.