Terms and Conditions

Welcome

The following information is provided to help you make an informed decision about participating in therapy, as well as to answer any questions you may have about office policies and treatment. Please feel free to discuss any questions or concerns you may have after reviewing the enclosed information.

Licensure

I am licensed by the State of California as a Marriage Family Therapist MU 17435. I have been licensed by the state of California since 1981. I have a Masters degree in Counseling Psychology.

Confidentiality

All clients are assured of confidentiality. Only a release of information, signed by you, may authorize me to discuss any information with other individuals. There are, however, important exceptions in which I am required by law to reveal information about you without your permission.

1. The law requires that I notify the intended victim and the appropriate law enforcement agencies if I judge that a patient had an intention to cause serious bodily harm or death to another individual.
2. I am obliged by law to report any suspected child abuse, neglect, or molestation to protect the child/children involved.
3. I am obliged by law to report any suspected abuse, neglect, or molestation of an elderly person or dependent adult involved.
4. It I assess a client to be suicidal, I am required by law to notify the individuals or agencies necessary to prevent self-harm, including initiating hospitalization on an involuntary basis if necessary.
5. In cases of alleged criminal or civil liability, I may be court ordered to release treatment information and/or records.
6. Some confidentiality will be lost in the insurance billing process. Additionally, if you have a managed care policy, clinical information is generally required in order to authorize reimbursement for services rendered. I will explain the issues surrounding these procedures if you have any questions.
7. I may determine it clinically necessary to discuss some aspects of your psychotherapy with another qualified professional in order to further your treatment goals. If I seek such consultation, neither your name nor any identifying information will be communicated.
8. I may release your name for collections processing. However, not treatment related information will accompany the disclosure.

Client’s Rights

1. You have the right to decide to end our psychotherapy work at any time. If you would like, I will provide you with the names of other qualified psychotherapists.
2. You have the right to learn about alternative methods of treatment. If you would like, I will discuss these with you during our work together.
3. You have the right to refuse the use of any therapeutic technique. I will inform you if I intend to use any unusual procedures and explain any risks involved.
4. You have the right to ask any questions about the procedures used in psychotherapy. If you would like, I will explain any usual methods of psychotherapy practice to you.

Emergency Coverage

You may leave messages for me 24 hours a day at (415) 456-0802. This information will be contained in my telephone message. Also, call the same number if there is an extreme emergency. In the event that I (or a covering therapist) cannot respond quickly, you should call your psychiatrist, your family physician, the emergency room of a local hospital, 911, or the 24-hour crisis team at 1-800-479-3339 or 1-800-784-2433.

Specific information will include discussion of physical injuries, illnesses, or conditions, mental (psychological or psychiatric) conditions and alcohol and/or drug abuse. This information is required for treatment planning and follow-up.

I may revoke this authorization at any time, except to the extent that action has been taken in reliance thereon. In any case, the authorization automatically expires in one year.

1. You are responsible for full payment of all psychological services.
2. Fees are payable at each session unless other arrangements have been made in advance.
3. The fee for a 45-minute individual therapy session is $150.00. Couples sessions are $150.00 (45-minutes) or 175.00 for an extended session (60-minutes). Each group session is $55.00. If group sessions are missed you are still responsible for the fee as long as you continue to be a group member (this holds your slot). If less than a 24-hour cancellation notice is given prior to your scheduled session you are responsible for the full fee. There is a $20.00 charge for all checks returned by the bank. Fees are periodically reviewed and changed. You will be given a 60-day notice of any fee increase.
4. The time I have for seeing patients is valuable and limited; therefore, I must charge you for your appointments if missed or canceled less than 24 hours in advance. Most insurance companies do not reimburse for missed sessions.
5. It is your responsibility to contact your insurance company and discuss the specifics of your mental health benefits prior to your appointment. As courtesy for you, my billing office will bill your primary and secondary insurance carriers.