We appreciate you choosing Beacon of Hope for your mental health care. This document outlines the services provided, the nature of treatment, patient responsibilities, and important legal and clinical information. Please read it carefully and feel free to ask questions before signing.

Services Provided:
We provide the following services as part of your care:

• Medication Management
• Psychoeducation
• Psychotherapy
• Diagnosis using DSM-5 criteria
• Pharmacogenetic Testing
• Drug Testing (via urine, blood, or saliva)
• Monitoring of appropriate diagnostic labs

Psychotherapy:
Psychotherapy ("talk therapy") is a powerful and evidence-based treatment for many emotional, psychological, and relational difficulties. It offers the opportunity to:

• Improve interpersonal relationships
• Reduce emotional distress
• Enhance self-awareness and goal setting

The process requires active participation, openness, and effort from both the patient and provider. While psychotherapy can be highly beneficial, it may bring up difficult emotions such as anxiety, sadness, guilt, or anger, especially in the early stages. These reactions are a normal part of the healing process. If such feelings arise, it is important to address them during your sessions.

At your initial appointment, your provider will complete a comprehensive review of your concerns and history. You will receive preliminary diagnostic impressions and a discussion of your treatment options, which may include psychotherapy alone or in combination with medication. If you feel the provider is not the right fit, we are happy to offer referrals to another professional.

Medication Management & Psychoeducation:
We may recommend medications when symptoms significantly interfere with daily functioning. If medication is considered appropriate:

• You will be informed about how the medication works, its expected benefits, potential side effects, interactions, and risks associated with abrupt withdrawal.
• The provider will ensure that all information is presented in a way that you can understand (psychoeducation) so that you can make an informed decision.

If you already have a therapist, Beacon of Hope will coordinate care with them, with your written consent.

Medication requires:

• Strict adherence to prescribed dosage and schedule
• Regular follow-up appointments and, when necessary, lab work
• Prompt reporting of side effects to your provider
• In emergency cases, go to the nearest emergency room and notify our office as soon as possible

Frequency and Duration of Appointments:

• Initial Visit: 60 minutes
• Follow-up (for medication): Typically 30 minutes every 2–4 weeks until stable, then monthly or as clinically indicated
• Your treatment plan will be discussed and tailored to your needs

Confidentiality:
Your privacy and confidentiality are protected under Ohio and federal law (including HIPAA). Your information will not be released without your written consent, except in specific legal or emergency circumstances outlined below:

Exceptions to Confidentiality (Mandatory Reporting):

1. Risk to Others: Threats to harm others will be reported to the potential victim(s), law enforcement, and/or appropriate authorities.
2. Risk to Self: If you are in danger of harming yourself, 911 will be contacted, and your emergency contact will be notified.
3. Court Orders: A judge may legally compel testimony in rare cases.
4. Driving Impairment: Certain neurological or psychiatric conditions (e.g., dementia, seizures) that impair driving may be reported to the Ohio BMV.
5. Abuse Reporting:
   1. Minors: Abuse or neglect involving minors will be reported to Child Protective Services (CPS).
   2. Adults: Abuse or neglect of dependent adults or elders will be reported to Adult Protective Services.
6. Grave Disability: If you are unable to meet basic needs due to a mental illness, we may be required to initiate hospitalization.

Whenever possible, we will discuss such matters with you before taking any action.

Referrals and Scope of Practice:

Beacon of Hope may refer you to a specialist if:

• Your condition requires a specific therapy (e.g., CBT, DBT, behavioral therapy)
• Your condition is beyond the provider’s scope of care

We are committed to helping you access the care you need, even if it means referring you to another provider.

Communication Policy:

• Email and texting are not secure methods for transmitting sensitive mental health information. Use the patient portal or call the office to leave a secure message.
• For emergencies, always call 911.

Consent to Treat:
By signing below, I acknowledge and agree to the following:

• I have read and understood the information above.
• I consent to receiving treatment from Beacon of Hope, including medication management, psychotherapy, lab testing, and other clinical services as recommended.
• I understand the benefits and risks of treatment, my rights to confidentiality, and the exceptions to confidentiality under Ohio law.
• I understand my responsibility to report any side effects, comply with the treatment, and notify the provider of any changes in my condition.