PROFESSIONAL DISCLOSURE

Thank you for choosing to work with me.

My name is Hilary Stevenson, LPC (Oklahoma License #6536). My office is located at:

9327 Pennsylvania Ave.
Oklahoma City, OK 73120

Phone: 405-771-0046
Email: hmu@hilarystevenson.com

I provide counseling services to adults seeking support with relationships, emotional well-being, personal growth, and life challenges. Counseling is tailored to each client's unique goals and circumstances.

NATURE OF COUNSELING

Counseling is a collaborative process designed to help clients increase self-awareness, improve relationships, develop new skills, and work toward meaningful personal goals.

Counseling may involve discussing difficult experiences, emotions, relationships, beliefs, behaviors, and patterns. At times, counseling may feel challenging or uncomfortable. Progress often involves exploring thoughts and feelings that have previously been avoided.

RISKS AND BENEFITS OF COUNSELING

Potential benefits of counseling include:

• Increased self-awareness
• Improved relationships
• Greater emotional well-being
• Improved coping skills
• Increased confidence and clarity
• Personal growth and development

Potential risks include:

• Temporary emotional discomfort
• Increased awareness of difficult feelings
• Changes in relationships
• Discovering aspects of yourself or your circumstances that are difficult to accept

Although counseling is often beneficial, no specific outcome can be guaranteed.

VOLUNTARY PARTICIPATION

Participation in counseling is voluntary.

Clients have the right to ask questions about the counseling process at any time and may decline any therapeutic intervention or recommendation.

CLIENT RIGHTS

The client has the right to ask questions about the counseling process, including what to expect during therapy and the goals of treatment.

The client has the right to decline counseling services at any time.

The client has the right to discontinue counseling services at any time. Discontinuation of services is subject to the discharge procedures outlined in the Financial & Scheduling Agreement.

The therapist reserves the right to terminate counseling services when clinically appropriate, ethically required, or otherwise necessary.

The client has the right to request access to their records in accordance with applicable state and federal laws.

EMERGENCY SERVICES

This practice does not provide emergency or crisis services.

If you are experiencing a mental health emergency, are at risk of harming yourself or someone else, or require immediate assistance, call 911, contact 988, or go to the nearest emergency room.

Clients should not rely upon text messages, email, voicemail, or other routine communication methods for emergency assistance.

NO GUARANTEE OF RESULTS

Counseling outcomes vary from person to person.

While counseling can be a valuable and effective process, no guarantees can be made regarding specific results, outcomes, or improvements.

COMPLAINTS

Clients are encouraged to discuss concerns directly with the therapist whenever possible.

Clients also have the right to contact the Oklahoma State Board of Behavioral Health Licensure regarding concerns about professional conduct.

CONFIDENTIALITY

Your privacy is important.

Information shared during counseling is confidential and will not be released to any person, agency, or organization without your written authorization, except when disclosure is permitted or required by law.

All records and information obtained during counseling are maintained in accordance with applicable state and federal laws and professional counseling standards.

LIMITS OF CONFIDENTIALITY

There are circumstances in which the therapist may be required or permitted by law to disclose confidential information without your written authorization.

These circumstances may include:

• You present an imminent risk of serious harm to yourself.

• You present an imminent risk of serious harm to others.

• Suspected child abuse or neglect.

• Suspected abuse, neglect, or exploitation of a vulnerable adult.

• A valid court order or other legal requirement.

• Situations otherwise required or permitted by state or federal law.

COURT PROCEEDINGS & LEGAL MATTERS

The therapist's primary role is to provide counseling services, not legal, custody, or forensic evaluation services.

The therapist considers protecting client confidentiality to be both an ethical and professional responsibility.

If records, testimony, or other information are requested through legal proceedings, the therapist will make reasonable efforts to protect your confidentiality and privacy to the fullest extent permitted by law.

Court involvement may affect the confidentiality of counseling records and communications.

The therapist does not guarantee that records or testimony can be withheld if disclosure is ultimately required by a valid court order or other applicable law.

You are encouraged to discuss any anticipated legal proceedings with the therapist as early as possible.

COORDINATION OF CARE

Information may be shared with other healthcare providers when necessary to coordinate your care. Except as otherwise permitted or required by law, such disclosures require your written authorization.

CLIENT RECORDS

You may request access to your records as permitted by law.

Requests for records should be submitted in writing.

TEXT MESSAGING

Text messaging may be used for scheduling, administrative matters, and routine communication.

Text messages are not a secure form of communication.

You should avoid sending highly confidential or sensitive information through text messages.

The therapist generally responds to text messages during normal business hours but does not provide twenty-four-hour availability or emergency response services.

Text messaging should never be used during a mental health emergency or crisis.

EMAIL COMMUNICATION

Email may be used for administrative purposes when appropriate.

Email is not guaranteed to be secure or confidential.

You should avoid sending highly confidential or sensitive information through email.

Email should never be used during a mental health emergency or crisis.

SOCIAL MEDIA

To protect client confidentiality and maintain professional boundaries, the therapist does not accept social media friend requests, follows, or other personal social media connections from clients.

The therapist does not communicate with clients through personal social media platforms.

You should avoid discussing sensitive information through social media messaging systems.

AUDIO RECORDING OF SESSIONS

Counseling sessions may be audio recorded for clinical purposes, including treatment planning, documentation, quality assurance, risk management, and quality-of-care review.

Audio recordings are maintained as confidential records and protected in the same manner as other counseling records.

Clients who do not wish to have sessions recorded must notify the therapist in writing.

EMERGENCY COMMUNICATION

This practice does not provide emergency or crisis services.

If you are experiencing a mental health emergency, are at risk of harming yourself or someone else, or require immediate assistance, call 911, contact 988, or go to the nearest emergency room.

Text messages, email, voicemail, and social media communications should never be relied upon for emergency assistance.

Thank you for choosing to work with me!

The purpose of this agreement is to clearly explain how scheduling, billing, and ongoing services operate so there are no surprises or misunderstandings.

RESERVED WEEKLY APPOINTMENT POLICY

Your regular weekly appointment time will be established during your intake session.

This appointment time is reserved exclusively for you and will remain reserved until services are formally discontinued in accordance with this agreement.

Because your appointment time is reserved specifically for you, weekly session fees are billed regardless of attendance unless otherwise provided in this agreement.

SESSION FEES

Intake Session (90 minutes): $250

Weekly Session (55 minutes): $185

WEEKLY BILLING

Weekly sessions are automatically billed at the beginning of each week using the payment method on file.

The weekly session fee is charged regardless of attendance because the appointment time remains reserved exclusively for you.

INSURANCE

The provider is an out-of-network provider and does not bill insurance directly.

Upon request, clients may receive a superbill to submit to their insurance company for possible reimbursement.

Insurance reimbursement typically requires the assignment of a mental health diagnosis, which becomes part of the client's permanent medical record.

Any reimbursement is paid directly to the client by the insurance company.

The provider cannot guarantee reimbursement, as coverage depends on the client's insurance plan, deductible, and carrier policies.

CLIENT SCHEDULING CONFLICTS WITH ADVANCE NOTICE

If you are unable to attend a session and provide at least two (2) weeks advance notice via text message, the therapist will attempt to offer an alternative appointment time during the week before or after the missed session.

Alternative appointments are subject to availability and are not guaranteed.

CLIENT SCHEDULING CONFLICTS WITHOUT ADVANCE NOTICE

If a scheduling change is requested with less than two (2) weeks notice, alternative appointment times may be offered at the therapist's discretion when available.

Alternative appointments are not guaranteed.

The regular weekly session fee will still apply.

PROVIDER SCHEDULING CHANGES

If the therapist must cancel or reschedule a session, reasonable efforts will be made to provide an alternative appointment time.

DISCONTINUING SERVICES

You may discontinue counseling services at any time.

To discontinue services, you must provide at least seven (7) days notice.

Upon discontinuing services, a final discharge session will be scheduled during your regularly reserved appointment time the following week and billed at your regular weekly rate.

The purpose of the discharge session is to provide appropriate clinical closure, review progress, discuss recommendations, and formally conclude the counseling relationship.

FAILURE TO ATTEND IS NOT DISCONTINUATION

Failure to attend sessions, failure to respond to communication, or simply stopping attendance does not constitute termination of services.

Failure to attend sessions does not cancel your reserved appointment time and does not end your financial obligations under this agreement.

Services remain active until you provide notice that you wish to discontinue services and complete the discharge process, or until the therapist formally terminates services.

PAYMENT ISSUES

Clients are responsible for maintaining a valid payment method on file.

If a payment is declined, the client is responsible for promptly updating payment information.

A $25 fee may be charged for failed payments that are not corrected on the same business day.

FINANCIAL RESPONSIBILITY

The client is responsible for all fees associated with services provided under this agreement.

FORM ACKNOWLEDGMENTS

 

ADDITIONAL ACKNOWLEDGMENTS