PRIVATE
PRACTICE POLICY
Welcome to my practice.
This document (the Agreement) contains important information
about my professional services and business policies.
Although these documents are long and sometimes complex,
it is very important that you read them carefully before
our next session. We can discuss any questions you have
about the procedures at that time. When you sign this document,
it will also represent an agreement between us. You may
revoke this Agreement in writing at any time.
MENTAL HEALTH SERVICES
Psychotherapy is not easily
described in general statements. It varies depending on
the personalities of the psychotherapist and client, and
the particular problems you are experiencing. There are
many different methods I may use to deal with the problems
that you hope to address. Psychotherapy is not like a medical
doctor visit. Instead, it calls for a very active effort
on your part. In order for the therapy to be most successful,
you will have to work on things we talk about both during
our sessions and at home.
Psychotherapy can have benefits and risks. Since therapy
often involves discussing unpleasant aspects of your life,
you may experience uncomfortable feelings like sadness,
guilt, anger, frustration, loneliness, and helplessness.
On the other hand, psychotherapy has also been shown to
have many benefits. Therapy often leads to better relationships,
solutions to specific problems, and significant reductions
in feelings of distress. But there are no guarantees of
what you will experience.
Our first few sessions will involve
an evaluation of your needs. By the end of the evaluation,
I will be able to offer you some first impressions of what
our work will include and a treatment plan to follow, if
you decide to continue with therapy. You should evaluate
this information along with your own opinions of whether
you feel comfortable working with me. If you have questions
about my procedures, we should discuss them whenever they
arise.
MEETINGS
I normally conduct an evaluation/history that will last
from 2 to 3 sessions. If psychotherapy is begun, I will
usually schedule one 50-minute session (one appointment
hour of 50 minutes duration) per week at a time we agree
on, although some sessions may be longer or more frequent.
Once an appointment hour is scheduled, you will be expected
to pay for it unless you provide 24 hours advance notice
of cancellation (unless we both agree that you were unable
to attend due to circumstances beyond your control.
If it is possible,
I will try to find another time to reschedule the appointment.
CONTACTING ME
Due to my work schedule, I am often not immediately available
by telephone. While I am usually in my office between 9
AM and 5 PM, I probably will not answer the phone when I
am with a client. When I am unavailable, my telephone is
answered by voice mail that I monitor frequently. I will
make every effort to return your call on the same day you
make it, with the exception of weekends and holidays. If
you are difficult to reach, please inform me of some times
when you will be available. [In emergencies, you can try
me on my cell phone.
| LIMITS ON
CONFIDENTIALITY |
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I may occasionally
find it helpful to consult other health and mental health
professionals about a case. During a consultation, I make
every effort to avoid revealing the identity of my patient.
The other professionals are also legally bound to keep
the information confidential. If you don't object, I will
not tell you about these consultations unless I feel that
it is important to our work together. I will note all
consultations in your Clinical Record (which is called
"PHI" in my Notice of Psychotherapist's Policies
and Practices to Protect the Privacy of Your Health Information).
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If you are
involved in a court proceeding and a request is made for
information concerning your diagnosis and treatment. I
cannot disclose any information without a court order.
If you are involved in or contemplating litigation, you
should consult with your attorney to determine whether
a court would be likely to order me to disclose information.
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If a government
agency is requesting the information for health oversight
activities, I may be required to provide it for them.
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If a patient
files a complaint or lawsuit against me, I may disclose
relevant information regarding that patient in order to
defend myself. |
PROFESSIONAL
RECORDS
It includes information
about your reasons for seeking therapy, a description of
the ways in which your problem impacts on your life, your
diagnosis, the goals that we set for treatment, you, your
progress towards those goals, your medical and social history,
your treatment history, any past treatment records that
I receive from other providers, reports of any professional
consultations. The Notes are for my own use and are designed
to assist me in providing you with the best treatment. While
the contents of Psychotherapy Notes vary from client to
client, they can include the contents of our conversations,
my analysis of those conversations, and how they impact
on your therapy. They also contain particularly sensitive
information that you may reveal to me. Nobody can receive
a copy of your Psychotherapy Notes without your Authorization.
You may examine and/or receive a copy of records, if you
request it in writing. Because these are professional records,
they can be misinterpreted and/or upsetting to untrained
readers. For this reason, I recommend that you initially
review them in my presence, or have them forwarded to another
mental health professional so you can discuss the contents.
PROFESSIONAL FEES/ BILLING AND PAYMENTS
You will be expected to pay for each session at the time
it is held, unless we agree otherwise. [In circumstance
of unusual financial hardship, I may be willing to negotiate
a fee adjustment or payment installment plan.]
