Privacy Policy

Welcome to Mental & Behavioral Health Counseling Services. It is my desire to make our time together as beneficial for you as possible.

I want to assure you that our sessions together will be kept in the strictest confidence. It is, however, important for you to understand that under certain circumstances the law

requires that I reveal the following information:

· reasonable suspicion of abuse to minor children or to the elderly

· client presents a serious and foreseeable danger to him/herself or to others

· when I am ordered to do so by a judge in a court of law.

· in the case of a law enforcement emergency

· pursuant to the Patriot Act in a situation of national security as dictated by a government official

Rest assured however, that I shall otherwise keep disclosures confidential at all times. If you are seen in a couples, family, or group setting, each person is encouraged to maintain confidentiality as well. I, however, have no control or responsibility for anything revealed by others outside of the sessions.

You are entitled to a copy of the Privacy Notice for your taking should you desire. If you decline a copy of the Privacy Rights, please sign and date the form stating as such. You have the right to be treated at all times with dignity and respect regardless of race, gender, age, sexual preference, or ethnicity. You may ask questions concerning your treatment, evaluation and assessment at any time and your questions will be answered in an honest and straight forward manner. You may also request and be shown the qualifications of the counselor and staff members who are involved with your treatment.

Before deciding to begin treatment, it would benefit you to understand my philosophy of counseling and to offer your expectations of results in counseling. Be advised that treatment may be difficult and emotionally painful as issues are worked through in the process. These times are usually short lived and can be beneficial to healing. There may come a time when issues from your family of origin are explored. There are no guarantees in counseling, but it is my intention to do whatever I can to facilitate you in achieving your goals.

The goals are yours to set. In this respect each person who comes for counseling has an individually planned treatment specific to his or her needs.

If it is decided that I am not the most beneficial or qualified counselor to help you with your specific issues every effort will be made to offer you appropriate referrals to professionals who I believe will be of more benefit to you.

Please be advised that I do have voice mail on my cell phone along with

texting. My voice mail is password protected and I do accept information regarding updates that are pertinent to your case. Please do not use texting for any form of counseling or reporting - only to schedule or reschedule appointments.

The fee for session is $80.00 per hour. Payment is expected at the start time of services unless prior arrangements have been made. I do not bill your insurance company; you are responsible for payment at time of service. If needed, I will provide you with receipts so you can submit for reimbursement. If for any reason you cannot keep your appointment, 24-hour prior notice of cancellation is required to avoid being billed for a missed appointment. The fee for a missed appointment with no prior notice will be $50.00. In the event your balance goes unpaid for more than 60 days, this office retains the right to seek restitution through a collection agency or filing a lien against you. Any fees or charges that arise from that will be added to the unpaid balance. You will be notified in writing prior to that action being taken. Returned checks will be charged the amount of the check plus a $25.00 processing fee, which must be paid prior to your next session. I am not equipped to handle mental health emergencies. Should you require emergency services, please dial 911 or go to your nearest emergency room.

By signing below, you agree that you have read this letter, have been given an

opportunity to ask whatever questions you deem necessary, you have received a copy of the Privacy Notice if requested, you agree to the terms of service, and wish to begin treatment.