Laya Seghi, LCSW

  • PRACTICE POLICIES, CONSENT FOR TREATMENT & PRIVACY PRACTICES

    Please initial to indicate that you have read the three sections below:

  • PRACTICE POLICIES:


    Appointments & Cancellations  At least 24 hours notice prior to your scheduled appointment is required or your full fee will be charged.  In case of a true emergency, you may discuss the circumstances in order to waive the fee.Fees  Fees are $300 for a 50 minute session; $375 for an extended session, and $175 for a half session (25 minutes).


    Telehealth  All of my sessions are done online via Google Meet, WhatsApp, FaceTime, or Doxy.me/layaseghi OR by telephone.  Between sessions, you may leave a voice mail message and I will respond as soon as possible.  If prolonged phone conversations are necessary, a charge will be made.  In the event of an emergency, call 911.  For other issues, in Miami, you may call JCS-Switchboard: 211 from a landline or 305.631.4211 from a mobile/cell phone ; in Broward, call 311. Dial 988 for the Suicide & Crisis Lifeline.


    Social Media  To maintain confidentiality and avoid dual relationships, I do not accept friend or contact requests from clients on social networking sites.


    Electronic Communication  I cannot ensure confidentiality of communication through electronic media, including text messages.  If you prefer to communicate via email or text messaging regarding scheduling, I will try to respond in a timely manner.


    Termination  It is important to have a termination process to achieve closure. The appropriate length of termination depends on the length and intensity of treatment.  Should you fail to schedule an appointment for four consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, I must consider the professional relationship discontinued.

    I have read and understand the above:

  • CONSENT FOR TREATMENT


    General Information  The therapeutic relationship is unique in that it is highly personal and a contractual agreement at the same time.  This consent provides a clear framework of our work together.  Feel free to discuss any of this with me.


    The Therapeutic Process  The outcome of your treatment depends largely on your willingness to engage in the process.  At times, this may result in considerable discomfort. Remembering unpleasant events and becoming aware of feelings attached to those events can produce strong feelings of anger, anxiety, depression, etc.  I cannot guarantee a specific desired outcome.  I can promise to support you and do my best to understand you and repeating patterns, as well as help you clarify what it is that you want for yourself.


    I have read and understand the above:

  • Privacy Practices  

    Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information.  By signing below, you  acknowledge that you have access to both a brief and longer version of the HIPAA Notice of Privacy Practices


    All relevant materials to your treatment will be held confidential unless you request in writing to have all or some content released to a specifically named person/persons.  Limitations of confidentiality are itemized in the Notice of Privacy Practices (a brief and longer version are available on my website for you to review). 


    To summarize, you have rights to your health information.  If you pose a threat of bodily harm to yourself or others, or if there is reasonable suspicion of physical, emotional or sexual abuse or neglect of children under 18 or of elders, or if ordered by subpoena or a court of law, confidentiality can be limited.  


    To ensure your privacy and confidentiality, if we accidentally see each other outside of the therapy session, I will not acknowledge you first.  However, if you acknowledge me first, I will be happy to speak briefly with you but will not engage in lengthy discussions in public or outside of the therapy session.

    I have read and understand the above:

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