LATE CANCELLATION OR NO SHOW 

The full fee will be charged for any session missed or canceled without 24 hour notice.
Clinician sees a fixed number of clients each week. Once you schedule an appointment with a Counselor, that time is reserved exclusively for you. therapists need to be able to rely on these therapy appointments. Therefore, therapists handle missed and canceled appointments as follows:
For any appointment that is missed or canceled with less than the required 24 hour notice, no matter what the reason, clients will be charged the full rate for that session. Also, keep in mind that missed or late canceled appointments are not covered by your health plan and cannot be billed to your insurance company.
Should you have any additional questions, please discuss them with your individual therapist.

In Case of Emergency 

IN CASE OF MENTAL HEALTH EMERGENCIES, PLEASE CONTACT ME DIRECTLY AT MY OFFICE.  IF I DON'T ANSWER, PLEASE LEAVE A MESSAGE CONCERNING YOUR EMERGENCY.  PLEASE NOTE, THERE IS A CHARGE FOR PHONE CONSULTATIONS AND INSURANCE COMPANIES ARE UNLIKELY TO REIMBURSE THIS SERVICE.  IN EXTREME EMERGENCIES, GO DIRECTLY TO YOU LOCAL EMERGENCY ROOM.   
YOU MAY ALSO CHOOSE TO CALL THE NATIONAL SUICIDE PREVENTION HOTLINE AT 1-800-273-8255.  

CLIENT RECORDS AND CONFIDENTIALITY

CLIENT ARE ASSURED OF CONFIDENTIALITY, WHICH IS PROTECTED BY ETHICAL PRACTICE AND LAW.  IN GENERAL, THE LAW STATES THAT ALL COMMUNICATION BETWEEN A LICENSED PRACTITIONER AND A HIS/HER CLIENT ARE CONFIDENTIAL. ANY INFORMATION SHARED WILL REQUIRE YOUR SIGNED CONSENT EXCEPT WHERE DISCLOSURE IS REQUIRED BY LAW.  SOME LEGAL EXCEPTIONS TO MAINTAINING CONFIDENTIALITY ARE: 
FEDERAL REGULATIONS ALLOW ME TO DISCLOSE NECESSARY DATE FROM YOUR RECORD IN ORDER TO OBTAIN PAYMENT FROM YOUR INSURANCE COMPANY.
IF I HAVE REASON TO SUSPECT A CHILD OR VULNERABLE ADULT IS BEING ABUSED OR NEGLECTED.  
IN CIRCUMSTANCES IN WHICH, TO THE BEST OF MY PROFESSIONAL JUDGMENT, I BELIEVE THAT YOU MAY BE AN IMMINENT DANGER TO YOURSELF OR ANOTHER.  
IF YOU WERE TO MAKE YOUR OWN MENTAL OR EMOTIONAL HEALTH AN ISSUE IN A COURT CASE. 
IF YOUR ACCOUNT IS OVERDUE AND ARRANGEMENTS FOR PAYMENT HAVE BEEN NEGOTIATED, A COLLECTION AGENCY WILL BE PROVIDED WITH THE DATES OF SERVICE, TYPE OF SERVICE PROVIDED, AND A TOTAL AMOUNT DUE.
MY HIPAA AND PRIVACY PRACTICES EXPLAIN IN DETAIL HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED. 

YOUR PRIVACY RIGHTS

PLEASE REVIEW THE PRACTICE POLICY SIGNED PRIOR TO THE START OF TREATMENT.  YOU CAN ACCESS THIS VIA THE CLIENT PORTAL.
If, in your opinion, I may have violated your privacy rights, or if you disagree with a decision I made about access to your PHI, you are entitled to file a written complaint with me at my office address. You may also send a written complaint to the Secretary of the Department of Health and Human Services within 180 days of a violation of your rights. I will not take retaliatory action against you for filing a complaint.
Additional Information: If you have any questions or need further assistance regarding this notice or to request assistance with any of the items listed above, please call me.