Welcome to my practice! This document contains information about my professional services, business policies, and laws pertaining to psychological services. Please read it carefully as it concerns your legal rights and responsibilities. Feel free to ask about anything that is not clear or that may not be covered here. At the end of this statement, you will be asked to consent to these terms and this document represents a formal agreement between us.
As a Psychologist licensed by the state of Tennessee, I subscribe to all laws and regulations of the state. Further, I subscribe to The Ethical Principles for Psychologists as published by the American Psychological Association. I am happy to share this information upon request.
I see patients by appointment only. Appointments are generally 55 minutes in length, though longer sessions may be scheduled depending upon individual needs. Appointments not kept or cancelled with less than 24-hours notice will be invoiced at the full rate. In emergency situations, patients need to call 911 or go to the nearest emergency room.
Fees for psychological services (e.g., psychotherapy, consultation, assessment) are to be paid in full at the time of service. Rates for appointments will be agreed upon during the new patient intake process or upon scheduling any custom sessions or packages. I accept payment in cash, check, or credit card. I do not accept or bill insurance. Upon request, I am glad to provide an invoice containing all the necessary information that you can submit directly to your health plan for reimbursement. If I am required to speak with third-party providers for your reimbursement, there will be a $25/15 minute fee.
In general, the privacy of all communication between the patient and myself is protected by law, and I can only release information to others with written permission by the patient or, in the case of a minor, the patient’s parent or legal guardian. However, there are some situations in which I am legally obligated to take action to protect others from harm, even if I have to reveal some information about a client. For example, if I believe that a child, elder, or disabled person has been abused, I must file a report with the appropriate state agency. If I believe that a client is threatening serious bodily harm to him/herself or another, I am required to take protective actions. These actions may include notifying the potential victim, contacting the police, or seeking hospitalization for the client. Should a report need to be filed or an action taken, I will make every effort to discuss it with the patient beforehand.
In the case of a subpoena, I will also be subject to share communications; however, in most legal proceedings, you have the right to prevent me from providing any information without your consent. While this written summary of exceptions to confidentiality should prove helpful in informing you about potential problems, it is important that we discuss any questions or concerns.
I have read the Office Policies and Informed Consent Statement for Paul W. Case, Psy.D,, LLC. I understand all important information contained in it and to my satisfaction. I have had the opportunity to ask questions and any questions have been answered to my satisfaction. I agree to abide by the policies and provisions contained in this agreement.