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Dear
Patients:
I
feel that I am better able to serve you if you
are aware of my office practices. Please read
over the following and then sign two copies, one
of which you should keep.
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.
CONFIDENTIALITY:
All communications between adult patients and
myself are kept strictly confidential.
Communications between child patients and myself
are kept relatively confidential as I explain to
children and adolescents that I will have some
contact with their parents. There are, however,
two exceptions to confidentiality:
If I am convinced that the
patient 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
patient or the safety of anyone else who is
threatened.
If a patient 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 886-5371.
If you are unable to reach me
then call 911 or go to the nearest emergency
room.
CANCELLATIONS:
The appointment time has been reserved for the
client. Subsequently, missed appointments and
non-emergency last minute cancellations with
less than 24 hours notice will be billed.
Insurance companies will not pay for missed
appointments.
APPOINTMENTS AND FEES:
The fee for the first one and a half hour
consultation is $475. Ongoing fifty minute
psychotherapy sessions are billed at $250 per
session. Fifty-minute psychopharmacology
sessions are billed at $300 per session.
Twenty-five minute psychopharmacology sessions
are billed at $175 per session. Phone calls
longer than 10 minutes will be billed at a
percentage of the hourly rate. Checks should be
made out to Zev Nathan. Payments are to be made
at the time of each session.
INSURANCE:
In some cases, health insurance plans will
reimburse clients for a specified portion of the
billed amount. I require that the client pay the
entire bill and then be reimbursed by the
insurance company. I will prepare a billing
statement at the end of each month for you to
attach to the insurance company claim form. I
will, of course, be happy to help if necessary.
DELINQUENT ACCOUNT POLICY:
Failure to pay your
account in a timely manner will result in legal
action or use of a collection agency. You will
be charged for all costs incurred for this extra
service.
Please click
here to print and sign
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