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Dear Patients:
I feel that I am best able to serve you if you
are aware of my office practices. Please read
over the following and sign two copies, keeping
one for your records.
EVALUATIONS: In order to develop a
treatment plan that we can all agree upon, I
have found it most productive to begin treatment
of children and adolescents, and often adults,
after an evaluation period. Critical information
collected will include strengths, interests and
challenges; goals and priorities; what works,
what doesn’t; critical people in the client and
family’s support system; and past response to
medications and alternative treatments.
CONFIDENTIALITY: All communications between
adult clients and myself are kept strictly
confidential. Communications between child and
adolescent clients and myself are kept
relatively confidential, as I explain to
children and adolescents that I will have some
contact with their parents. In order to maintain
trust with adolescents, I provide them with an
oral summary of all conversations and emails
with parents, and when appropriate share email.
There are, however, two exceptions to
confidentiality:
If I am convinced that the
client will do harm to him or herself, or to
someone else, I am required by law to take
appropriate measures to assure the safety of the
client or the safety of anyone else who is
threatened.
If a client reveals child abuse
(sexual, physical, or emotional), I am required
by law to report such matters to the Child
Protective Services or the appropriate
authorities.
EMERGENCY PROCEDURE: If you are in crisis
and need emergency assistance, contact me at
570.6749. If you are unable to reach me, please
call 911 or go to the nearest emergency room.
CANCELLATIONS: The appointment time has been
reserved for the patient. Subsequently, missed
appointments and non-emergency last minute
cancellations with less than 24 hours notice
will be billed.
APPOINTMENTS AND FEES: Fifty-minute
psychotherapy and psychopharmacology sessions
are billed at $300 per session. Thirty-minute sessions are billed at $200 per
session. Medication Management only patients are
required to come in on a quarterly basis.
Patients who fail to schedule a quarterly
session will be charged $75 per refill, and
required to come in before needing the next
refill.
While there is no cost
for short phone calls, phone calls over
10 minutes are billed proportional to my rate of
$300/hour.
INSURANCE: In some cases, health insurance
plans will reimburse clients for a specified
portion of the billed amount. I require that
patients pay their entire bill and then be
reimbursed by the insurance company.
DELINQUENT ACCOUNT POLICY: Unpaid
accounts are forwarded to a collection agency.
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