PRACTICE POLICIES

APPOINTMENTS AND CANCELLATIONS

The standard meeting time for psychotherapy is 45-55 minutes.  It is up to you, however, to determine the length of time of your sessions.  Requests to change the session time needs to be discussed with the therapist for time to be scheduled in advance.

If you noshow or cancel within 24 hours 3 times in a months period, your case will be reviewed and a discussion of termination or referral to another provider may proceed.

Cancellations and re-scheduled session will be subject to a $50 cancellation fee if NOT RECEIVED AT LEAST 24 HOURS IN ADVANCE.  Your card on file will be charged. By signing this form you agree to have your card on file charged automatically for late cancellations or no shows. This is necessary because a time commitment is made to you and is held exclusively for you.  If you are late for a session, you may lose some of that session time.

TELEPHONE ACCESSIBILITY

If you need to contact me between sessions, please leave a message on my voice mail, please do not text.  I am often not immediately available; however, I will attempt to return your call within 24 hours.  Please note that Face- to-face sessions are highly preferable to phone sessions.  Due to the COVID-19 pandemic I am also offering telehealth, video sessions are preferred to telephone sessions.  If we must do a session via telephone, I will have you verify your identity for privacy purposes.  If you feel you cannot wait for a return call or if you feel unable to keep yourself safe:

1.     (In Arizona) contact Crisis Response Network at 1-800-631-1314

2.     go to your Local Hospital Emergency Room, or

3.     call 911.

SOCIAL MEDIA AND TELECOMMUNICATION

Due to the importance of your confidentiality and the importance of minimizing dual relationships, I do not accept friend or contact requests from current or former clients on any personal social networking site (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 publish a blog and I post counseling news on Instagram.  I have no expectation that you as a client will want to follow my blog, or Instagram.  However, if you use an easily recognizable name on these platforms and I happen to notice that you have followed me there, we may briefly discuss it and its potential impact on our working relationship.  If you follow me my professional page, I will not follow you back, nor communicate with you on that platform.  If you have questions about this, please bring them up when we meet and we can talk more about it.

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, I will do so.  While I may 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 chose 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.

(6) 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 essential information, that you may not recognize as significant to present verbally the therapist.

COURT INVOLVEMENT/DISABILITY/ CUSTODY

It is our policy to have no court involvement regarding divorce, custody, or disability claims.  Court involvement is not within our scope of work.  Custody, disability and FMLA assessment is not within our scope of work.  I understand that courts can appoint professionals who can conduct independent evaluations and make recommendations to the court.  By signing this form, we are both agreeing not to use any of my therapeutic intervention records or testimony in any future court proceedings.  There is also a separate form you will fill out titled INFORMED CONSENT FOR A MINOR.  If your court case requires my participation, you will be expected to pay for the professional time required even if another party compels me to testify in court.  Any fees associated with court involvement will be your responsibility at the rate of $200.00 an hour.

TERMINATION

Ending relationships can be difficult.  Therefore, it is important to have a termination process to achieve some closure.  The appropriate length of the termination depends on the length and intensity of the treatment.  I may terminate treatment after appropriate discussion with you and a termination process if I determine that the psychotherapy is not being effectively used or if you are in default on payment.  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 psychotherapists to treat you.  You may also choose someone on your own or from another referral source.

Should you fail to schedule an appointment for three consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, I must consider the professional relationship discontinued.

RECORDS

You have the right to request that a copy of your file be made available to any other health care provider at your written request.  Any request for records will require a signed Release of Information form indicating reason for request.  If a minor’s parents are divorced, both parents need to fill out the request unless one party has full legal custody.  For DCS children, the DCS legal guardian will need to fill out the ROI.  Records include but are not limited to, progress notes, treatment plan, and assessments.  We do have the right to limit and/or refuse sharing records based on A.R.S. § 12-2293.  Records will be provided in accordance with confidentiality guidelines and will be provided within 30 days of written request.  There is a standard record fee of $5.

BY CLICKING ON THE CHECKBOX BELOW I AM AGREEING THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.