Welcome to Thoughtful Connections Counseling!
It is a pleasure to have you in our practice. We appreciate the opportunity to work with you. In order to provide clarity and transparency with our practice this letter has been prepared for your information.
Informed Consent: Before obtaining any counseling care, it is important to gain sufficient knowledge regarding the types of treatment available, any risk, and potential benefits. This process of information gathering is known as receiving “informed consent”. Although we will not make decisions for you, we will, however, be available to assist you in making alterations and understanding their impact on you and others. We will always keep you informed of any changes in therapy that we may propose and any risks we foresee. In addition, we may suggest alternatives to therapy so that you can make well-informed decisions about your treatment.
Appointments/Payments: This office operates on an appointment basis. In order for your time to be reserved, it is essential that you make appointments in advance. Each appointment is a clinical hour, which is 50 minutes. If you need to cancel an appointment, please do so at least 24 hours in advance, so that you will not be charged for the session. A $99.00 fee will be assessed for appointments cancelled within 24 hours of the scheduled visit. If for any reason, you need to cancel your appointment, you are responsible for contacting our office. You may leave a message with our answering service or voice mail, and you may also email us at firstname.lastname@example.org. Although we may not receive the notification until the following business day, we will refer to the timestamp. Documented efforts MUST be made for your cancellation fee to be waived.
A "No Show"/ missed appointment for a scheduled appointment will incur a $99.00 fee. This fee will be due and payable directly from the client and will not be billed to your insurance company. Thoughtful Connections, LLC clients are required to provide a credit/debit card to be held on file in our secure database to ensure a guarantee of payment in the event of “No-Show” or cancellation within 24 hours. You have a 15 minute grace period. You will be notified of the cancellation/no show fee at the time of the missed appointment, and of the charges applied to your account. You will also be notified via e-mail and sent a receipt for the transaction. This fee must be paid before any further counseling sessions will be allowed. This in no way will compromise your ability to dispute a charge or question your insurance company’s determination of payment.
As a courtesy, you may receive a call or email from our office confirming your appointment. The call/email may occur within 24-72 hours of your scheduled appointment. This is a courtesy of our office. If you do not receive a courtesy call/email reminder, you are still expected to arrive as scheduled for your appointment.
Termination of Services: It is your right to terminate our relationship at any time. We would appreciate a one week notice so that we might meet to discuss the termination and your future plans. At that time, we can assist you in locating another counselor and you may authorize the transfer of your records if necessary.
Confidentiality: With few exceptions, our conversations are confidential. State law, federal regulations and our Code of Ethics specifically guarantee this confidentiality. There are some situations however, in which confidentiality cannot be guaranteed. They fall within the following categories:
1. We must notify appropriate persons if we feel that a client may harm him/herself or another individual. (This is our duty to warn.)
2. We must report the abuse, neglect, or exploitation of children or the elderly.
3. We are required to respond to a subpoena accompanied by a court order.
4. We conduct periodic peer reviews of client cases for best professional practices as well as for supervision purposes.
Emergency Procedures: We are committed to being responsive to your needs. However, there may be times when we are unavailable. If you need immediate help, you should contact one of the resources below:
• Call Behavioral Health Link/GCAL: 800-715-4225
• Call Ridgeview Institute at 770-434-4567
• Call Peachford Hospital at 770-454-5589
• Call Lifeline at 800-273-8255 (National Crisis Line)
• Call 911
• Go to the emergency room of your choice.
Billing and Insurance: The fee for counseling services may be up to $250.00 for each clinical hour. Self- pay clients are responsible for the session fee at the time services are rendered. If you have insurance coverage, we will be happy to assist you in filing claims on your behalf. Rates may change at any time; however, we will do our best to notify you in advance of any changes.
When insurance is used, a co-payment or full payment of the session (depending on plan deductibles) may be required. Client payments are dictated by your insurance company. All client payments are due at the time of each session.
Disability/Personal Client Paperwork: All disability and other related forms received in this office from your insurance company, or otherwise received on your behalf to be completed by your therapist, may incur a service fee up to $300.00 per occurrence. Any follow-up, second-tier, dispute, or additional set of forms may incur an additional fee up to $250.00. All fees must be paid in advance by the client. Fees are not billable to an insurance company or Employee Assistance Program (EAP). Forms may only be completed during a scheduled office visit.
Interaction with the Legal System I understand that I will not involve or engage my therapist in any legal issues or litigation in which I am a party to at any time either during my counseling or after counseling terminates. This would include any interaction with the Court system, attorneys, Guardian ad Litems, psychological evaluators, alcohol and drug evaluators, or any other contact with the legal system. In the event that I wish to have a copy of my file, and I execute a proper release, my therapist will provide me with a copy of my record, and I will be responsible for charges in producing that record.
If I believe it necessary to subpoena my therapist to testify at a deposition or a hearing, I would be responsible for his or her expert witness fees in the amount of $1,500.00 for one-half (1/2) day to be paid five (5) days in advance of any court appearance or deposition. Any additional time I spend over one-half (1/2) day would be billed at the rate of $375.00 per hour including travel time. I understand that if I subpoena my therapist, he or she may elect not to speak with my attorney, and a subpoena may result in my therapist withdrawing as my counselor.