Welcome to my practice! This document contains important information about my professional services and business policies. Please read it carefully. Once you sign this, it will constitute a binding agreement between us.

Therapy is an active effort that requires participation of both the therapist and client. In order for therapy to be successful, you will have to work both during our sessions and at home. Therapy has both benefits and risks. The risks sometimes include experiencing uncomfortable levels of feelings like sadness, guilt, anxiety, anger, frustration, loneliness, helplessness, etc. Therapy has also been shown to have lasting benefits as well. It often leads to a significant reduction in feelings of distress, improvement in relationships, and helps to resolve specific problems. However, as in anything in life, there are no guarantees about the outcomes. By the end of the first hour, we can decide together if I will be an appropriate fit for you or your child. I specialize in play therapy with an emphasis on sand play therapy and I offer sand play to all of my clients as a powerful therapeutic tool. I have experience working with adults in a community agency setting with a focus on anxiety and depression. I am currently in training for EMDR (Eye Movement Desensitization and Reprocessing) therapy and am able to offer this therapeutic method to my clients who have experienced trauma, anxiety, and suffer from phobias. I take a collaborative approach to therapy and request that if you have doubts about me as your therapist, please let me know so that I can help secure you an appropriate consultation with another mental health professional.

My normal practice is to conduct an intake session, during which time, we can decide if I am the best person to provide the services that you need. If we decide to continue with therapy, I will usually schedule one 50-minute session per week at a mutually agreed upon time (although this may vary depending on client Once this appointment is scheduled, you will be expected to pay for it unless you provide 24 hours advance notice of cancellation or we both agree that you were unable to attend due to circumstances beyond your control. If you do not provide 24 hours notice, you will be charged for half the session fee.

Sessions

$125 in office

  $75 via telehealth

My fee is $125 per 50-minute session ($75 with telehealth) and I'm currently only taking cash payment. In addition to appointments, it is my practice to charge this amount on a prorated basis for other professional services you may require such as report writing, attendance at meetings or consultations with other professionals (with whom you have authorized), preparation of records or treatment summaries, or the time required to perform any other service which you may request of me. In unusual circumstances, you may become involved in legal matters. You will be expected to pay for the professional time required, even if I am compelled to testify for another party. Because of the complexity and difficulty of legal involvement, I charge $300 per hour attendance at any legal proceeding, related to my clinical practice.

You will be expected to pay for each session at the time it is held. Payment schedules for other professional services will be negotiated at the time these services are requested. In circumstances of unusual financial hardship, I may be willing to negotiate a fee adjustment or installment payment plan. I require a credit card on file upon starting services. This information will be kept confidential and locked. I accept the following forms of payment: *Ivy pay (preferred method of payment) * Check If your account is more than 60 days in arrears and suitable arrangements for payment have not been agreed to, I have the option of using legal means to secure payment, including collection agencies or small claims court. If such legal action is necessary, the costs of those proceedings will be included in the claim. In most cases, the only information that I would release about a client's treatment would be the client's name, the nature of the services provided, and the amount due. It is not unusual, however; that a judge may subpoena an entire case record.

I am currently solely accepting Cash Pay clients.

to resolve any objections either parents or children may have about what I am prepared to disclose.

In general, the confidentiality of all communication between a client and mental health provider are protected by law. Thus, I can only release information about our work to others with your written permission. However, there are some important exceptions to note. In most judicial proceedings, you have the right to prevent me from providing any information about your treatment. However, in some circumstances, such as child custody proceedings and proceedings in which your emotional condition 1S an important element, a judge may require my testimony if he/she determines that a resolution of the issues before him/her demands it. In these situations, my case records may be subpoenaed. There are some situations in which I am legally required to take action to protect others from harm, even though that requires revealing some information about a client's treatment. If I believe that a child, an elderly person, or a disabled person is being abused, I must file a report with the appropriate agency. If I believe that a client is threatening serious bodily harm to another, I am required to take protective action; which may include notifying the potential victim, notifying the police, or seeking appropriate hospitalization for the client, including contacting family members or others who can help provide protection. I may occasionally find it helpful to consult with other professionals regarding a case. Ibelong to a sand play consultation group, which meets monthly. I may present pictures taken of the sand trays created during the therapy process to this group. Specific identifying client information is not shared with the group and presentations are made solely for training purposes. Consultants in this group are also legally bound to keep the information confidential. While this written summary of exceptions to confidentiality should prove helpful in informing you about potential problems, it is important that we discuss any questions or concerns that you may have at our next session. As you might suspect, the laws governing these issues are complex. an attorney, thus; should you need specific advice, formal legal counsel may be desirable.

Your signature below indicates that you have read the information in this document and agree to abide by its terms during the professional relationship

Client signature Date: Guardian signature Date: (required for clients under eighteen)