Lisa M Nardi P.C.

 

1. Unless there is an emergency, all the therapy sessions are private and confidential with the exception of specific exceptions described below:

    a. Child, elder or dependant abuse,

    b. Expressed threats of violence toward an ascertainable victim,

    c. Detailed planning or concrete signs of future suicide attempts,

    d. Sharing information is necessary to facilitate client care across providers

    e. Sharing information may necessary for the treatment.

    f. Requests from legal and administrative institutions.

 

2. With the Client's prior written consent, the Lisa M Nardi may legally speak to another healthcare provider or Client's family members in emergency situations. The Client may direct the Lisa M Nardi to share information with whomever the Client desires, and the Client may change his/her mind anytime and revoke the permission.

3. Lisa M Nardi is allowed to keep brief notes of the therapy session which shall be kept in strict confidence. The Client may, at any time request a copy of the notes kept during the therapy session.

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

5. The Client may decline to proceed the therapy as to the techniques which may be conducted by the therapist.

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

7. Lisa M Nardi has the right to dismiss the Client from the course of therapy.

 

By initialing below, you acknowledge and understand the items listed under Client's Rights.

1. I hereby authorize Lisa M Nardi P.C. to use the telehealth practice platform for telecommunication for evaluating, testing and diagnosing my medical condition.

2. I understand that technical difficulties may occur before or during the telehealth sessions and my appointment cannot be started or ended as intended.

3. I accept that the professionals can contact interactive sessions with video call; however, I am informed that the sessions can be conducted via regular voice communication if the technical requirements such as internet speed cannot be met.

4. I understand that my current insurance may not cover the additional fees of the telehealth practices and I may be responsible for any fee that my insurance company does not cover.

5. I agree that my medical records on telehealth can be kept for further evaluation, analysis and documentation, and in all of these, my information will be kept private.

 

By initialing below, you agree to the line items listed under Telehealth Consent

Acknowledgement

I have reviewed this Professional Counseling Informed Consent Agreement. Please direct any questions to Lisa M Nardi prior to signing this consent:

Following an evaluation period, if continued treatment with Lisa M Nardi is recommended, I agree to actively participate in treatment.

I am aware that I may stop treatment in collaboration with Lisa M Nardi at any time. As appropriate, I will be given alternate referrals. I will remain responsible for payment of service that I have already received.

I understand Lisa M Nardi P.C. will submit claims to my insurance company on my behalf. I am responsible for any co-pay and deductible associated with my account.

I accept this agreement and consent to counseling.