Welcome to Creative Touch Counseling Center LLC. We look forward to providing you with efficient, quality, and supportive counseling services. This document contains important information about my professional services and business policies. When you sign this document, it will constitute a contract between you and Creative Touch Counseling Center LLC, (hereinafter referred to “The Practice”). The Practice team cares about you and wants you to make an informed decision with your informed consent concerning the counseling services you will receive and our business policies. Please read it carefully and jot down any questions you might have so that we can discuss them at our next meeting.

THE COUNSELING PROCESS. The counseling process is a partnership between you and The Practice to work on areas of dissatisfaction in your life or assist you with life goals. For counseling to be most effective, it is important that you take an active role in the process. This involves keeping scheduled appointments, listening to the counselor, being honest with the counselor, discussing the counseling process with the counselor, and completing outside assignments agreed upon with the counselor. Counseling can have both benefits and risks. While counseling can be of benefit to most people, the counseling process is not always helpful. The counseling process also can evoke strong feelings and sometimes produce unanticipated changes in one’s behavior. It is important that you discuss with the counselor any questions or discomfort you have regarding the counseling process or any behavioral changes you may be experiencing. Your counselor may be able to help you understand the experience and/or use different methods or techniques that may be more satisfying.

COUNSELING. is a confidential process designed to help you address your concerns, come to a greater understanding of yourself, and learn effective personal and interpersonal coping strategies. It involves a relationship between you and a trained counselor who has the desire and willingness to help you accomplish your individual goals. Counseling involves sharing sensitive, personal, and private information that may at times be distressing. During the course of counseling, there may be periods of increased anxiety or confusion. The outcome of counseling is often positive; however, the level of satisfaction for any individual is not predictable. Your counselor is available to support you throughout the counseling process.

CONFIDENTIALITY. We highly respect the privacy and confidentiality of each of our clients. We likewise believe that for counseling to be effective and successful, we must make our clients feel secure about the information that they disclose with us. We keep our clients' records in a secure manner and we do not allow it to be accessed or to be shared with anyone else unless with the written consent of our client who owns the information, both clinical information and personal. If records receive no update within a period of 7 years, we purge the records for privacy protection.

However, we would like to let you know that privacy has its limitations in law and we would like to inform you of the circumstances where we may share information to a 3rd party without your consent:

• Acts of sexual abuse or misconduct
• Criminal acts
• Acts of abuse towards others such as neglect towards children, disabled, or the elderly
• Acts that the therapist believe may cause harm to the client himself or to others
• Compelling legal orders by the court, but nonetheless we will inform the client immediately prior to compliance with the order.
• In case the client is below legal age, we may disclose information to parents or legal guardians.

COUNSELING DECISIONS. Frequency of sessions, number of sessions, goals, type of counseling and any alternative counseling methods will be discussed and negotiated between you and your counselor. You are encouraged to regularly discuss your progress and review your goals with your counselor. If you have questions about recommendations or the approaches used by the counselor, please discuss your questions or concerns with the counselor. If you feel these recommendations are not appropriate, you may refuse to accept them. If you feel you are not making satisfactory progress toward your goals, please discuss this with your counselor. If you are not able to resolve questions or concerns you have about the progress of counseling, the process of referring to another provider will be implemented.

ACCESS TO SERVICES. Counseling services are available by appointment only. Please remain informed about the hours of operation as listed and regularly updated on the website: www.creativetouchcounseling.com. Appointment availability can also be provided by calling Creative Touch Counseling Center LLC at (470) 829-6301. Creative Touch Counseling Center LLC does not operate during holidays and the counselor reserves the right to make changes and updates to their availability as needed. An individual in crisis or imminent danger is advised to immediately dial 911 or visit your local emergency room for an evaluation and assessment for safety. Creative Touch Counseling Center LLC does not provide an after hour crisis line, does not provide 24hr contact services, nor operates as a crisis stabilization entity.

ELECTRONIC COMMUNICATION. Creative Touch Counseling Center LLC seeks at all times to maintain and respect the confidentiality of each client, including not only the details of any services rendered, but also the fact that an individual may be in contact with Creative Touch Counseling Center LLC. With this in mind, Creative Touch Counseling Center LLC wishes to remind each person that electronic communication (e.g., email, texts, messenger through any social media platforms, or faxes) is not a secure form of communication. Because confidentiality cannot be assured, the use of electronic communication is discouraged in regard to communications with Creative Touch Counseling Center LLC, with the exception of direct appointment scheduling through the website scheduling page: www.creativetouchcounseling.com.  Electronic communication may be used for scheduling appointments, but should not be used for counseling purposes or major forms of communication. The suitability of any clinical consultations or recommendations can only be determined through counseling sessions. Electronic communication is not appropriate for emergency or time-critical situations. The fastest way to contact Creative Touch Counseling Center LLC is by phone. Please call your counselor or the office directly (470) 829-6301. if your message is time-critical. If it is after office hours and you are in imminent crisis, please call 911 or visit one of your nearest emergency rooms. 

INSURANCE REIMBURSEMENT.

f you have a health insurance policy, it will usually provide some coverage for mental health treatment.  I will fill out forms and provide you with whatever assistance I can in helping you receive the benefits to which you are entitled; however, you (not your insurance company) are responsible for full payment of my fees.  It is very important that you find out exactly what mental health services your insurance policy covers.

You should carefully read the section in your insurance coverage booklet that describes mental health services.  If you have questions about the coverage, call your plan administrator. 

Due to the rising costs of healthcare, insurance benefits have increasingly become more complex.  It is sometimes difficult to determine exactly how much mental health coverage is available. “Managed Health Care” plans often require authorization before they provide reimbursement for mental health services.  These plans are often limited to short-term treatment approaches designed to work out specific problems that interfere with a person’s usual level of functioning.  It may be necessary to seek approval for more therapy after a certain number of sessions.  Though a lot can be accomplished in short-term therapy, some clients feel that they need more services after insurance benefits end.  Some managed-care plans will not allow me to provide services to you once your benefits end.  If this is the case, I will try to assist you in finding another provider who will help you continue your counseling.

You should also be aware that most insurance companies require that I provide them with your clinical diagnosis.  Sometimes I have to provide additional clinical information, such as treatment plans, progress notes or summaries, or copies of the entire record (in rare cases).  This information will become part of the insurance company files.  Though all insurance companies claim to keep such information confidential, I have no control over what they do with it once it is in their hands.  In some cases, they may share the information with a national medical information databank.  I will provide you with a copy of any records I submit, if you request it.  You understand that, by using your insurance, you authorize me to release such information to your insurance company.  I will try to keep that information limited to the minimum necessary.

SESSION APPOINTMENTS. Each session takes 50 minutes. Counseling sessions are on the reservation and by appointment. In case the client will not be able to attend the scheduled appointment, he/she should call 24-hours prior appointment or he/she will be charged $70 cancelation fee.

FEES. Fees are charged on a per session basis. We may directly bill your insurance company by informing us of the details. If you planning to pay out of pocket, here are our schedule of fees:

• 50 Minute Indivdidual Counseling Session ($90- 17 years and younger; $120- adults)
• Marriage Counseling ($150)
• Family Counseling ($150)
• Requested paperwork completion: $125 initial; $25 additional updates to paperwork as required
• Court Witness (expert witness) ($200 per hour)

 

Session Fees for Contract Therapists are provided per individual therapist.

Session Fees for Clinical Interns and Students are a reduced cost

 

RELATIONSHIP. The relationship required for effective counseling is strictly professional. This is for the best interest of the parties. The therapist cannot have any other relationship with the client than a professional one. 

MINORS

Parent Authorization for Minor’s Mental Health Treatment

In order to authorize mental health treatment for your child, you must have either sole or joint legal custody of your child.  If you are separated or divorced from the other parent of your child, please notify me immediately.  I will ask you to provide me with a copy of the most recent custody decree that establishes custody rights of you and the other parent or otherwise demonstrates that you have the right to authorize treatment for your child.

One risk of child therapy involves disagreement among parents and/or disagreement between parents and the counselor regarding the child’s treatment.  If such disagreements occur, I will strive to listen carefully so that I can understand your perspectives and fully explain my perspective.  We can resolve such disagreements or we can agree to disagree, so long as this enables your child’s therapeutic progress.  Ultimately, parents decide whether therapy will continue.  If either parent decides that therapy should end, I will honor that decision, unless there are extraordinary circumstances.  However, in most cases, I will ask that you allow me the option of having a few closing sessions with your child to appropriately end the treatment relationship.

Individual Parent/Guardian Communications with Me

In the course of my treatment of your child, I may meet with the child’s parents/guardians either separately or together.  Please be aware, however, that, at all times, my patient is your child – not the parents/guardians nor any siblings or other family members of the child.

If I meet with you or other family members in the course of your child’s treatment, I will make notes of that meeting in your child’s treatment records.  Please be aware that those notes will be available to any person or entity that has legal access to your child’s treatment record. 

Mandatory Disclosures of Treatment Information

In some situations, I am required by law or by the guidelines of my profession to disclose information, whether or not I have your or your child’s permission.  I have listed some of these situations below.

Confidentiality cannot be maintained when:

• Child patients tell me they plan to cause serious harm or death to themselves, and I believe they have the intent and ability to carry out this threat in the very near future.  I must take steps to inform a parent or guardian or others of what the child has told me and how serious I believe this threat to be and to try to prevent the occurrence of such harm.
• Child patients tell me they plan to cause serious harm or death to someone else, and I believe they have the intent and ability to carry out this threat in the very near future.  In this situation, I must inform a parent or guardian or others, and I may be required to inform the person who is the target of the threatened harm [and the police].
• Child patients are doing things that could cause serious harm to them or someone else, even if they do not intend to harm themselves or another person.  In these situations, I will need to use my professional judgment to decide whether a parent or guardian should be informed.
• Child patients tell me, or I otherwise learn that, it appears that a child is being neglected or abused--physically, sexually or emotionally--or that it appears that they have been neglected or abused in the past.  In this situation, I am required by law to report the alleged abuse to the appropriate state child-protective agency.
  I am ordered by a court to disclose information.
  Disclosure of Minor’s Treatment Information to Parents

Therapy is most effective when a trusting relationship exists between the counselor and the patient.  Privacy is especially important in earning and keeping that trust.  As a result, it is important for children to have a “safe zone” where children feel free to discuss personal matters without fear that their thoughts and feelings will be immediately communicated to their parents.  This is particularly true for adolescents who are naturally developing a greater sense of independence and autonomy.

It is my policy to provide you with general information about your child’s treatment, but NOT to share specific information your child has disclosed to me without your child’s agreement.  This includes activities and behavior that you would not approve of — or might be upset by — but that do not put your child at risk of serious and immediate harm.  However, if your child’s risk-taking behavior becomes more serious, then I will need to use my professional judgment to decide whether your child is in serious and immediate danger of harm.  If I feel that your child is in such danger, I will communicate this information to you.

Example: If your child tells me that he/she has tried alcohol at a few parties, I would keep this information confidential.  If you child tells me that he/she is drinking and driving or is a passenger in a car with a driver who is drunk, I would not keep this information confidential from you.  If your child tells me, or if I believe based on things I learn about your child, that your child is addicted to drugs or alcohol, I would not keep that information confidential.

Example: If your child tells me that he/she is having voluntary, protected sex with a peer, I would keep this information confidential.  If your child tells me that, on several occasions, the child has engaged in unprotected sex with strangers or in unsafe situations, I will not keep this information confidential.

You can always ask me questions about the types of information I would disclose.  You can ask in the form of “hypothetical situations,” such as: “If a child told you that he or she were doing ________, would you tell the parents?”

Even when we have agreed to keep your child’s treatment information confidential from you, I may believe that it is important for you to know about a particular situation that is going on in your child’s life.  In these situations, I will encourage your child to tell you, and I will help your child find the best way to do so.  Also, when meeting with you, I may sometimes describe your child’s problems in general terms, without using specifics, in order to help you know how to be more helpful to your child.

Disclosure of Minor’s Treatment Records to Parents

Although the laws of [this State] may give parents the right to see any written records I keep about your child’s treatment, by signing this agreement, you are agreeing that your child or teen should have a “safe zone” in their meetings with me, and you agree not to request access to your child’s written treatment records.

Parent/Guardian Agreement Not to Use Minor’s Therapy Information/Records in Custody Litigation

When a family is in conflict, particularly conflict due to parental separation or divorce, it is very difficult for everyone, particularly for children.  Although my responsibility to your child may require my helping to address conflicts between the child’s parents, my role will be strictly limited to providing treatment to your child.  You agree that in any child custody/visitation proceedings, neither of you will seek to subpoena my records or ask me to testify in court, whether in person or by affidavit, or to provide letters or documentation expressing my opinion about parental fitness or custody/visitation arrangements. 

 

CONSENT

I understand that this consent is purely voluntary. I have had the opportunity to discuss any concerns with regard to the services and treatment and by which all questions were answered accordingly and to my satisfaction. 

I understand that I can withdraw anytime from the therapy by informing my therapist. By signing below, I expressly give my consent to the treatment and therapy sessions with the therapist.