and Limits of Liability
Therapy sessions carry both benefits and risks. Therapy sessions can significantly reduce the amount of distress someone is feeling, improve relationships, and/or resolve other specific issues. However, the improvements and any "cures" cannot be guaranteed for any condition due to the many variable that affect these therapy sessions. Experiencing uncomfortable feelings, discussing unpleasant situations and/or aspects of your life are considered risks of therapy sessions.
What you discuss during your therapy session is kept confidential. No contents of the therapy sessions, whether verbal or written may be shared with another party without your written consent or the written consent of your legal guardian. The following is a list of exceptions:
If you disclose a plan or threat to harm yourself, the therapist must attempt to notify your family and notify legal authorities. In addition, if you disclose a plan to threat or harm another person, the therapist is required to war the possible victim and notify legal authorities.
If you disclose, or it is suspected, that there is abuse or harmful neglect of children or vulnerable adults (i.e. the elderly, disabled/incompetent), the therapist must report this information to the appropriate state agency and/or legal authorities.
Therapists must report any admitted prenatal exposure to controlled substances that could be harmful to the mother or the child.
Parents or legal guardians of non-emancipated minor clients have the right to access the clients' records.
Insurance companies and other third-party payers are given information they request regarding services to the clients.
The type of information that may be requested includes: types of services, dates/times of service, diagnosis, treatment plan, description of impairment, progress of therapy, case notes, summaries, etc.
If you are unable to attend an appointment, we request that you provide at least 24 hours advanced notice to our office. Since we are unable to use this time for another client, please note that you will be billed for the entire cost of your scheduled appointment if it is not timely cancelled, unless such cancellation is due to illness or emergency.
For cancellations made with less than 24 hour notice (unless due to illness or an emergency) or a scheduled appointment that is completely missed, you will be mailed a bill directly for the full session fee.
We appreciate your help in keeping the office schedule running timely and efficiently.
Your information will be encrypted.
Your browser does not support capabilities required for electronic signatures.
Click a signature you want to use: