• Single Session/Phone Call Therapy Assessment Consent Form

  • ESE Mental Health is happy to introduce Single Session/Audio Call Therapy Assessment!

    This modality can be used for people who may not have an established mental health provider and need immediate services to determine if treatment is advised. There is no expectation of continuing services after the single session. The following policies apply only to Single Session/Audio Call Therapy Assessment.

    Use of Single Session/Audio Call Therapy Assessment

    This service is not primarily for crisis intervention and should be used to help clients facing a variety of concerns and want to get guidance from a mental health professional. If the mental health provider identifies a crisis or other urgent matter, they may refer the client to other higher levels of care.

    Using these services DOES NOT establish the client as a regular therapy client. These services are solely SINGLE SESSION therapy assessment. If you need continued services, you will have the opportunity to submit your information for a regular intake to be established with a provider regularly.

    Session Make-up

    Each session will include a brief explanation about informed consent for therapy services, identification of the problem the client is wanting to be seen for, exploration of current resources and previous attempts to resolve concerns, presentation of recommendations and interventions regarding concerns.

    At this time, ESE Mental Health does not bill insurance or charge for Single Session/Audio Call Therapy Assessment.

    Acknowledgement of Informed Consent

    By signing below, you are acknowledging the following:

    I have received and reviewed a copy of the Single Session/Audio Call Therapy Assessment Consent Form. I understand the information contained in this form and consent for myself to receive services ESE Mental Health.

    I consent to audio/telephonic assessment.

  • Format: (000) 000-0000.
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