Welcome to Radical Elevation (RE). This document contains important information about our professional services, your rights, and our business policies. Please read it carefully and note any questions you have so we can discuss them at your next appointment. When you sign this document, it will represent an agreement between you and Radical Elevation.
Scope of services
Radical Elevation is a bilingual mental and behavioral health clinic offering individual, family, and group therapy to children, teens, and adults. Our multidisciplinary team includes licensed clinicians with various specialties, and services may be provided in person or via secure telehealth, depending on what best fits your treatment plan.
Psychotherapy varies depending on the personalities of the clinician and client and the goals you hope to address. For therapy to be most successful, it requires an active effort on your part, including working on topics discussed in sessions between appointments.
Psychotherapy can involve both benefits and risks. You may experience uncomfortable feelings such as sadness, guilt, anger, frustration, loneliness, or helplessness when exploring difficult topics. However, therapy has also been shown to provide benefits, such as improved relationships, solutions to specific problems, and meaningful reductions in distress.
In the first few sessions, your clinician will work with you to evaluate your needs and create a treatment plan. If at any point you have questions or doubts about your care, please discuss them with us. If you wish, we can assist you in arranging a second opinion with another professional.
Note: While RE offers crisis intervention services as part of treatment, we do not provide emergency or after-hours crisis services, psychiatry, or medication management.
Appointments, Cancellations, and Attendance
During the initial sessions, your history will be collected, your needs will be identified, and it will be evaluated whether your therapist at Radical Elevation is the right fit for your treatment goals.
Clients are expected to give as much notice as possible when canceling or rescheduling an appointment. While we understand that emergencies may arise, frequent disruptions can affect the continuity of care and appointment availability.
Radical Elevation has a formal policy regarding late cancellations, no-shows, and patterns of disruption. If these occur repeatedly, your recurring appointments may be removed, and future sessions will need to be scheduled individually. You may also lose access to high-demand appointment times.
For more details on timelines, fees, and conditions, please review and sign the Cancellations, Late Cancellations, and No-Shows Policy Consent Form.
Client responsibilities
As a client, you agree to:
- Attend scheduled appointments regularly
- Participate actively in your treatment
- Communicate honestly about any questions, concerns, or barriers
- Provide timely updates regarding insurance or billing changes
- Notify us promptly of any scheduling issues or the need for accommodation
Billing and payments
If you are covered by Medicaid, your sessions will be billed through insurance. Otherwise, you are expected to pay for each session at the time it occurs unless a different arrangement is made. Please communicate with us if you have questions about your payment responsibilities.
Insurance reimbursement
Most insurance companies require RE to provide them with a clinical diagnosis, and in some cases, additional information such as treatment plans, progress notes, or summaries. This information becomes part of the insurance company’s files, and RE has no control over how they handle it once submitted. If requested, we can provide you with a copy of the records sent to your insurer. By using your insurance, you authorize RE to release necessary information for billing purposes.
Communications with RE
RE clinicians are often not immediately available by phone. If you are experiencing an emergency, call 911 or go to the nearest emergency room.
You may contact your clinician or the RE office by email, text (if consented), or phone for routine matters. We aim to respond within 48 business hours, excluding weekends and holidays. Please note that email is not HIPAA-protected. If your clinician will be unavailable for an extended time, we will provide you with an alternative contact if needed.
Administrative staff may also reach out to you about scheduling, billing, or forms as part of supporting your care.
Confidentiality
In general, your privacy is protected by law, and we cannot share information about your care without your written consent. However, there are specific exceptions:
If we believe you pose an immediate threat to yourself or others, we may take protective actions, including notifying others or arranging hospitalization
If we suspect abuse or neglect of a child, elderly person, or disabled adult, we are required to report this to authorities
If ordered by a court, we may be required to release information or provide testimony
We may consult with other professionals about your care; identifying details are minimized, and consultants are bound by confidentiality
Additional details about privacy protections, HIPAA, telemedicine, and the use of artificial intelligence tools are outlined in separate consent documents you will also review and sign.
Community resources and referrals
As part of supporting your overall well-being, RE clinicians may recommend referrals to community resources or outside agencies, with your consent, if additional services or supports are needed beyond therapy.
Agreement
Your signature below indicates that you have read this document, understand its contents, and agree to its terms as part of your care with Radical Elevation.