Informed Consent for Counseling (PDF)
Informed Consent for Counseling (Word Document)

Patient Mental Health Bill of Rights (PDF)
Patient Mental Health Bill of Rights (Word Document)

HIPPA, Notice of Privacy Practices (PDF)
HIPPA, Notice of Privacy Practices (Word Document)

Policy on Cancellations and Missed Appointments:

Times set aside for therapy sessions are not easily filled when they are cancelled without notice. Unless you give at least 24 hours notice, you will be expected to pay $50 for a missed appointment.

Confidentiality

Therapy provides a safe space to talk openly, so you can feel listened to and understood, without fear of judgment. To this end, therapeutic confidentiality ensures that communication between therapists and their clients is protected by law. Information about our communications can be released only with your permission. In specific emergency situations, a therapist is required by law to breach confidentiality. These situations include serious threat to self or others; reasonable suspicion of abuse or neglect of a child or dependent adult; court order; voluntary release signed by the client or guardian; and during supervisory consultation.

Fee:
The fee to see me is $125.00. All workshops and programs carry their own individual costs and are not covered by insurance.

I accept cash and personal checks.

Insurance:

As a Licensed Clinical Counselor, I provide my professional services for a fee. These services are covered by various insurance plans. Please check with your insurance provider to verify that counseling is covered, as you are ultimately responsible, financially, for the services provided. I will of course provide therapy and other mental health services to individuals who are not covered by the plans that are carried by my practice. In such cases the client will carry the financial responsibility for receiving services.

You may need to obtain authorization from your insurance provider to meet with me prior to your first session. It is also important that you determine if there are session limits, and what the co-pay is for your insurance plan. Please bring your insurance identification card to your first appointment.

Insurance companies typically require that licensed mental health professionals provide them with confidential client information, including a  mental health diagnosis, to make sure treatment and payment falls within their policy guidelines. My practice handles all health care information in accordance with HIPPA regulations.

I am an approved provider with the following insurance companies:

• Anthem Blue Cross/ Blue Shield
• Aetna
• First Health
• Harvard Pilgrim
• MHNet
• MMC Physician -Hospital Organization
• United Behavioral Health
• Optum Health Behavioral Solutions
• Pacificare Behavioral Health
• Humana
• Martin’s Point
• Value Options