Jeffrey Nelson, LCSW, PLLC
1805 S. Bellaire St. Ste: 219 Denver, CO 80222

INFORMED CONSENT

Termination of duty of care, automatically terminates if / when a client does not have contact with the therapist after 4 weeks.

There is a fee for sessions that are either missed or not cancelled 24 hours or more prior to the scheduled appointment. The fee range is between $60.00 and $140.00. The fee must be paid immediately to preserve future appointments.

There is a fee of $420.00 for report writing of any kind; for testimony and driving time to and from any deposition and/or testimony.

There is a fee of $.39 for copying of chart records.

There is a fee for any telephone calls that go beyond 5 minutes at the rate of $140.00 per hour.

There may be a fee for any time consulting with other care providers.

A release of information is required for all physicians the client is being treated by, for any medical or psychiatric issue.

This therapist uses Cognitive Behavioral Therapy as well as Client Centered therapy. There are other alternative treatments available by other psychiatric providers some of which are identified below:

Dialectical Behavioral Therapy; Eye Movement Desensitization Reorganization; Brain Spotting; Cognitive Therapy; Behavioral Therapy; Group Therapy; Family Therapy; Community Resources such as 12-Step groups; Substance Abuse therapy; Transcranial magnetic stimulation, (TMS); Electroconvulsive therapy, (ECT) and others. This list is not meant to be exhaustive alternative, alternative treatments available.

If I am in a position to resist disclosure for any litigation issues, you will be responsible for any attorney fees I would incur to defend such.

By signing below, you are confirming you are aware of these policies and practices and that you are entering into treatment at your own will and can terminate at any time. You can always seek a second opinion at any point.