We are pleased that you have chosen Anisa Grantham, LPC, MAC/Rincon Recovery Resources (RRR)
There are several things we want you to know before we begin discussing your reason for coming.
I. Confidentiality and Privacy
Personal problems are sometimes difficult to talk about. That is why confidentiality is extremely important to us. We take every precaution in protecting the confidentiality of your visit with us, and we hope you will also do the same.
Recent legislation (the Health Insurance Portability and Accountability Act, HIPAA) is also meant to protect your privacy. In accordance with HIPAA, we have given you the "Georgia Notice Form" describing in detail how psychological and medical information about you may be used and disclosed and how you can get access to this information.
Your signature below indicates you have been given the "Georgia Notice Form" regarding " Anisa Grantham, LPC, MAC/Rincon Recovery Resources Policies and Practices to Protect the Privacy of Your Health Information.”
II. Billing, Payments, and Missed Appointments
You will be expected to pay for each session at the time of service, unless we agree otherwise. If you have insurance, we are glad to provide you with a statement of the services received.
If it is necessary to cancel an appointment, we ask that you do so a full working day before the scheduled time. It is our policy to charge for appointments canceled with less than the requested notice and missed appointments.
Please sign below to indicate (1) that you have been given the “Georgia Notice Form” with RRR policies and Practices to Protect the Privacy of Your Health Information and (2) that you agree to our billing, payments and missed appointment policies.