HELPING YOU HEAL HABITS THAT HURT

(408) 800-5736 6105 Snell Ave Suite 101 San Jose, CA 95123 aft@counselingrecovery.com www.CounselingRecovery.com

Information about Michelle Farris, LMFT

Please read the entire document carefully and be sure to ask me any questions you may have regarding its contents. Your therapist is a licensed Marriage and Family Therapist. At an appropriate time, your therapist will discuss their professional background with you and provide you with information regarding their experience, education, special interests, and professional orientation. You are free to ask your therapist questions at any time. Patient acknowledges and understands the Michelle Farris is a sole-proprietor and owner of Counseling Recovery. This is an individual private practice.

Fees and Insurance: The fee for service is $185 per 50-minute individual or couples therapy session. The fee for service is $210 per 60-minute individual or couples therapy session. The fee for service is $750 for an individual substance abuse assessment. Phone and emergency contacts over 10 minutes are billed at the same rate.

Individual sessions are approximately 50 and 60 minutes in length. However, at certain points you and your therapist may determine that longer sessions are necessary in advance or a crisis may arise that necessitate a longer session. Fees are payable at the time services are rendered. Please ask if you wish to discuss a written agreement that specifies an alternative payment procedure.

This counseling practice does not accept insurance, but I'm happy to provide receipts for services so you can be reimbursed through your insurance company, if allowable. Please inform your therapist if you wish to use health insurance to pay for services, and your therapist can make appropriate referrals.

You should be aware that insurance plans generally limit coverage to certain diagnosable mental conditions. You should also be aware that you are responsible for verifying and understanding the limits of your insurance coverage. Although we are happy to assist your efforts to seek insurance reimbursement, we are unable to guarantee whether your insurance will provide payment for the services provided to you. Please discuss any questions or concerns that you may have about this with your counselor. Iffor some reason you find that you are unable to continue paying for your therapy, please let your counselor know, and they will help you to consider other options that may be available.

Confidentiality: All communications between you and me will be held in strict confidence unless you provide written permission to release information about your treatment. If you participate in marital or family therapy, your therapist will not disclose confidential information about your treatment unless all person(s) who participated in the treatment with you provide their written authorization to release.

There are exceptions to confidentiality. For example, therapists are required to report instances of suspected child or elder abuse. Therapists may be required or permitted to break confidentiality when they have determined that a patient presents a serious danger of physical violence to another person or when a patient is dangerous to him or herself. In addition,a federal law known as The Patriot Act of 2001 requires therapists (and others) in certain circumstances, to provide Michelle Farris, with books, records, papers and documents and other items and prohibits the therapist from disclosing to the patient that Michelle Farris, sought or obtained the items under the Act.

If you participate in marital or family therapy, your therapist will not disclose confidential information about your treatment to outside individuals or entities unless all person(s) who participated in the treatment provide their written authorization to release such information. However, it is important that you know that your therapist utilize a "no-secrets" policy when conducting couples therapy. This means that if you participate in family and/or marital/couples therapy, your therapist is permitted to use information obtained in an individual session you may have had with me, when working with other members of your family. In other words, the decision on whether or not to disclose that information will be based on your therapist's professional judgment and discretion. Please feel free to ask your therapist about how this "no secrets" policy may apply to you.

Record Keeping: Therapist may take notes during session, and will also produce other notes and records regarding your treatment. These notes constitute Therapist's clinical and business records, which by law, Therapist is required to maintain. Such records are the sole property of Therapist. Therapist will not alter her normal record keeping process at your request. Should client request a copy of Therapist's records; such a request must be done in writing. Therapist reserves the right under California law, to provide you with summary in lieu of actual records. Therapist also reserves the right to refuse to produce a copy of the record under certain circumstances, but may as requested; provide a copy of the record to another treating health care provider. Therapist will maintain your records for ten years following termination of therapy. However, after ten years, your records will be destroyed in a manner that preserves your confidentiality

Appointment Scheduling and Cancellation Policies: Sessions are typically scheduled to occur one time per week at the same time and day, if possible. Your therapist may suggest a different amount of therapy, depending on the nature and severity of your concerns. Your consistent attendance greatly contributes to a successful outcome. In order to cancel or reschedule an appointment, please notify me at least 24 hours in advance of your appointment. If you cancel with less than 24 hours notice, you are responsible for the cost of the missed session. There are two options to avoid the fee; do the session by phone, or if I have an opening in the same week, that will be offered to you. If you need to cancel, this late fee will be charged from a credit card kept on file. If you are late to a session,I will wait for 20 minutes and after that time, your session will be missed.

Therapist Availability/Emergencies Telephone consultations between office visits are welcome. However, Michelle Farris will attempt to keep those contacts brief due to your therapist's belief that important issues are better addressed within regularly scheduled sessions.

You may leave a message for Michelle Farris at any time on her confidential voicemail. If you want Michelle Farris to return your call, please be sure to leave your name and phone number(s), along with a brief message concerning the nature of your call. Texts and emails are for non-counseling issues however these communications are not secure. Non-urgent phone calls are returned during normal workdays (Monday through Friday) within 24 hours. Your therapist is not available to return routine calls on Saturdays or Sundays or after 8 pm. If you have an urgent need to speak with Michelle Farris, please indicate that fact in your message. In the event of a medical emergency or an emergency involving a threat to your safety or the safety of others, please call 911 to request emergency assistance.

Patient Litigation and Requests for letters: Therapist will not voluntarily participate in any litigation, or custody dispute in which Patient and another individual, or entity, are parties. Therapist has a policy of not communicating with Patient's attorney and will generally not write or sign letters, reports, declarations, or affidavits to be used in Patient's legal matter. If a letter is requested and agreed upon, Patient agrees to reimburse Therapist at the rate of $185 per hour pro-rated to time for writing letters. Therapist will generally not provide records or testimony unless compelled to do so. Should Therapist be subpoenaed, or ordered by a court of law, to appear as a witness in an action involving the Patient, Patient agrees to reimburse Therapist for any time spent for preparation, travel, or other time in which Therapist has made herself available for such an appearance at the hourly rate of $350. This rate applies only to Patient Litigation only.

About the Therapy Process: Based upon the information that you provide and the specifics of your situation, your therapist will provide recommendations to you regarding your treatment. Your therapist believes that therapists and patients are partners in the therapeutic process. You have the right to agree or disagree with your therapist's recommendations. You and your therapist will also periodically exchange feedback regarding your progress. Due to the varying nature and severity of problems and the individuality of each patient, your therapist is unable to predict the length of your therapy or to guarantee a specific outcome or result.

Online Therapy: All of my counseling sessions are conducted online using a HIPPA complaint platform. It is my expectation that you will benefit from online therapy, but there is no guarantee. Therapy is conducted using either interactive video or audio. Online-based services as care may not be as complete as face-to-face, or appropriate for your need. If I assess that in person is more appropriate, I will offer an appointment or provide referrals.

Limitations of Online Therapy: Telemedicine services and care may not be as complete as in person services. If I also believe that you would be better served by in person services, I will be referred to a psychotherapist who can provide such services in my area. Finally, understand that there are potential risks and benefits associated with any form of psychotherapy, and that despite my efforts and your efforts, your condition may not improve, and in some cases may even get worse.

Termination of Therapy: The length of your treatment and the timing of the eventual termination of your treatment depend on the specifics of your treatment plan and the progress you achieve. It is a good idea to plan for your termination, in collaboration with me. Your therapist will discuss a plan for termination with you as you approach the completion of your treatment goals. If you decide to terminate, you agree to come in for a termination session. You may discontinue therapy at any time. If you or your therapist determines that you are not benefiting from treatment, either of us may elect to initiate a discussion of your treatment alternatives. Treatment alternatives may include, among other possibilities, referral, changing your treatment plan, or terminating your therapy.

Absences: In the event I am out of town or am unavailable, I have an agreement with trusted colleagues for them to 'cover' and take emergency calls in my absence. I have chosen these licensed mental health care providers with great care and will share only necessary information with them that will allow them to provide appropriate care for you. This information may include a summary of your diagnosis, any specific areas of concern, and our treatment plan. Unexpected Absences I am ethically and professionally bound to ensure that you receive competent care in the eventI am unable to continue to provide it for whatever the reason. Just like you, unplanned things can happen to me including sickness, accidents and even death. In the event I am ever unableto continue to provide my services to you, I have identified a trusted colleague who will manage my practice and act as a Bridge Therapist and other therapists who may offer continuing care if I am unable to.

In order to accomplish this, he/she will have access to your contact information in the event something happens to me. This person will contact you to inform you of my situation and status, offer to either meet with you and or make referrals to other practitioners whom I have identified and trust.

The Board of Behavioral Sciences receives and responds to complaints regarding services provided within the scope of practice of (marriage and family therapists, licensed educational psychologists, clinical social workers, or professional clinical counselors You may contact the board online at www.bbs.ca.gov, or by calling (916) 574-7830.

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