Dear Client,
I would like to list my office procedures and policies to better assist you and to clarify the situation.
1. The rate for individual counseling is $250. The rate for family/couples counseling is $275. Rate for consultation is $250. Sessions are forty-five minutes.
2. The time for your appointment is reserved strictly for you. If you cannot make the appointment, please cancel 24 hours in advance. There are no exceptions to this policy. You will be charged the full fee for cancellations with less than 24 hours notice.
3. If you are late for your appointment, you will be charged for the full appointment. Unless I am notified, I generally consider more than 20 minutes late to be a cancelled appointment. Client who cancel less than 24 hours in advance will be charged the full fee.
4. There are no charges for phone calls to change appointments. Phone calls to discuss anything other than rescheduling an appointment will be charged in quarter-hour increments.
I respond to phone calls Tuesday through Friday, from 10:00 a.m. to 5:30 p.m., unless I am out of the office.
5. Please call 911 for emergency situations.
6. If you have insurance, please let me know at the first session. Our office will provide you with a statement for you to submit to your insurance company for potential reimbursement. Admin charges occur if not informed by the 4th session. You are responsible for verifying and understanding the limits of your insurance coverage. Professional services are charged directly to you.
7. Please notify me within 30 days of any change in address or telephone number.
8. Time for writing reports, correspondence, reviewing certification materials, etc will be charged for in quarter-hour increments.
9. This business is conducted by a marriage and family therapy corporation.
10. This agreement is to provide a clear understanding. I look forward to working with you.
Sincerely,
Sherry Reasbeck, Ph.D.
Licensed Marriage, Family, and Child Therapist #22431
I have read the above terms and understand and agree to them. I promise to pay the charges provided herein, and realize that I am legally bound to do so.