The client may ask questions on what to expect during and end result of the therapy.

The client may decline to proceed with therapy at any time, 

The client may cease to continue therapy anytime, without any impediment and may return to therapy anytime. 

Upon deciding to discontinue services, a mandatory discharge session will be scheduled and billed for the following week at the client's regularly scheduled appointment time.

The therapist has the right to dismiss the client from the course of therapy.

The client has the right to review his or her records from the therapist.

Right to confidentiality: Within limits provided for by law, all records and information acquired by the therapist shall be kept strictly confidential in accordance to the principles of a doctor-patient relationship. 

Limits to client confidentiality:

- The client is an imminent and violent threat towards themselves or others
- There is a billing situation which requires a condoned disclosure
- Sharing information is necessary to facilitate client care across multiple providers. This disclosure requires consent from the client in writing.

The following situations obligate the provider to break confidentiality:

- Detailed planning of future suicide attempts
- Other concrete signs of suicidal intent
- Planned violence towards others
- Planned future child/elder abuse (by client or others)
- Formerly committed child/elder abuse (by client or others)
- Experiencing child/elder abuse (by client or others)
- Expecting to experience future child/elder abuse (by client or others)

All information will not be shared or revealed to any person, agency, or organization without the prior written consent of the client.

The client can raise any concerns and to speak with the therapist immediately of any concerns provided that the therapist is likewise available to discuss matters with the client.

How a NO CANCELLATION POLICY works
Your regualr weekly timeslot will be scheduled in your intake (initial) session. This appointment timeslot is yours until you no longer wish to come in for weekly sessions. 

Important: You can discontinue services at any time, at which point a one-time discharge session at your weekly rate will be billed to your card on file and scheduled for your reserved timeslot the following week. 

Why does the provider use this policy?
This policy allows you the peace of mind knowing that you will always be able to get in, plan financially, and eliminate misunderstandings with scheduling/billing. 

Provider Cancellations
If, at any time, a change in schedule is required by the provider, we will work together to accomodate a make-up session that fits your schedule. 

Client Conflict (With Advance Notice)
If a client is unable to attend a session, and gives the provider a written (sent via text message) two-week advance notice, the client will be offered an additional time slot on the week prior or following the missed session. 

Client Conflict (Without Advance Notice)
If, at any time, a change in schedule is requested by the client without two weeks advance notice, the provider may, at her discretion, provide additional scheduling options, when possible. This is not guaranteed, and the client will still be charged at the weekly rate. 

Session rates:

- Intake sessions are $250 for (90 min) initial session.

- Weekly sessions are $185 for (55 min) session.

Insurance:

Provider is considered an out-of-network provider for insurance, and is able to provide a detailed invoice, also known as a "superbill," if requested by the client. This form will include all of the pertinent details for you to submit to your insurance provider for possible reimbursement. Please understand that any insurance reimbursement requires a formal mental health diagnosis to be given by the provider, which will become part of the client's permanent medical record. Any insurance reimbursement will be sent directly to the client, and not to the provider. Provider is unable at this time to know if any reimburement will be provided by the insurance, which is subject to the insurance provider's policies, as well as the client's deductible and insurance plan.

Hilary Stevenson, LPC, is a licensed professional counselor with several years of experience specializing in various counseling.

We value our relationship with our clients and believe that such relationship is the beacon in the healing process. 

We believe that each individual is unique and has his own way of addressing resolutions. Thus, we believe in a wellness model that helps our clients empower themselves by focusing on what works for them, within our systems-based approach.

We are not a fit for everyone, nor can we meet every need you might have. Fortunately, we work with an amazing network of providers and specialists and take our job very seriously to work together to get you to a provider/specialist that can get you the relief and results you need and want.

Acknowledgement I have reviewed this Professional Counseling Informed Consent Agreement and Policies. I likewise understand my Client's Rights and all other policies set forth in these forms. I accept this agreement and consent to counseling.