CLIENT THERAPIST AGREEMENT The therapy relationship is a collaborative one.
You and I will establish goals together and work to accomplish them.
In order to facilitate our work, there are a number of policies and procedures that
need to be followed. They are outlined below:
OFFICE HOURS I generally work day hours only, from early morning till before
dinner. I am open to being reached at other times and am often liberal about
responding to my clients as well, especially through email. (see below for details).
FINANCIAL AGREEMENT & CANCELLATION POLICY
My fee for private clients is $300 for a 50-minute session and pro-rated for any
time that is less than that. If the session requires additional time, there will be a
prorated charge based on the fee amount listed.
I accept credit cards, checks, or cash, and payment is expected on the day of
treatment. I do NOT accept cash pay platforms such as paypal, zelle. etc.
Because your appointment time is held exclusively for you, I have a general 24-
hour cancellation policy.
PHONE CALLS, TEXTS, and EMAILS
If your situation requires attention outside of regular working hours, please call
or text my cell phone at 917-586-5360, leave a detailed message, and I will
respond as soon as I am able.
If the calls and responding takes more than around 8 minutes, then I generally pro
rate the time and bill accordingly.
If the situation is life-threatening, please contact 911.
CONDUCT OF THERAPY
I adhere to the Code of Ethics as a clinical social worker (LCSW) and to the laws of
New York and nationally as they pertain to client-therapist relationships.
The content of all professional interactions in my practice will be held in
confidence unless you waive this confidentiality in writing (email is acceptable).
However, confidential information can be subpoenaed by court order, although it
doesn’t happen often.
Additionally, information concerning child or elder abuse, physical violence, or
threats to others or self is REQUIRED BY LAW to be reported to the designated
authorities. Therefore, this kind of information will not be kept confidential.
CONFIDENTIALITY WAIVER Under federal law, you have the right to confidentiality
with regards to treatment and treatment sessions you receive. This means that
without prior consent from a client. However, to provide therapy services with a
holistic approach, it is common practice to ask clients to allow the therapist to
speak with other service providers they are seeing such as: psychiatrists,
psychotherapists, medical professionals, etc.
For those clients under 18 years of age: parents/guardians may be asked to give
consent for me to speak to your teenager’s school or other specialists.