Thomas Roe, Psy. D.

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Thomas Roe, Psy.D.
Welcome to my office at Rainier Behavioral Health. The following information is provided to familiarize you with my practice and background.

CREDENTIALS: I am a licensed clinical psychologist in Washington and California. I was born and raised in Tacoma, WA. I completed my undergraduate education at the University of Puget Sound and my professional training at the Washington School of Professional Psychology. I completed my predoctoral internship at the University of Idaho and my postdoctoral residency at the University of California, Davis. I spent six more years at UC Davis as Coordinator of Graduate Student Counseling Services before joining Rainier Associates. I am also an adjunct professor at Middlebury Institute of International Studies at Monterey.

APPOINTMENTS: Your appointment time is held exclusively for you. It is important that you arrive on time for your appointment, as it cannot be extended. If you are unable to keep your appointment for any reason, please contact the office at least 24 hours in advance to cancel or reschedule; otherwise, you will be charged $75 for the missed session. Insurance will not pay for missed sessions; you will be responsible for the charge. If a pattern of no shows/ late cancellations occurs you will need to obtain care elsewhere. We are able to provide outside referrals for your convenience.

PROCESS OF THERAPY: I provide individual and couples counseling (18-65 years old). I am also open to providing outreach including presentations, workshops, and training to various groups in the community. My professional interests include stress/anxiety, depression, peak performance, eating disorders, substance abuse/addictions, relationship issues, adjustment, trauma and intersections of identity and culture. I consider myself to be a generalist with recent experience in higher education working with undergraduate and graduate students, medical/law students, and those hoping to improve focus, attention, motivation, and work efficiency.

I consider social justice an important piece of my work striving for equity and social opportunity. I use a wide variety of collaborative approaches in therapy, depending on the nature of the work, identities present in the room, and cultural considerations. I enjoy being creative using a variety of interventions including cognitive-behavioral therapy (CBT), psychodynamic, humanistic, and feminist modalities. I utilize the relationships in the room, motivational interviewing, mindfulness, and interpersonal process to further personal development and positive change. I tend to use a casual and open approach to the therapy process and appreciate humor. My overall goal is to help individuals maximize their life potential and thrive.

EMERGENCY CALLS: An answering machine takes all emergency calls outside of regular business hours. If you are concerned about your immediate safety (self- harm or harm to others) I would suggest calling 911 or the pierce county crisis line at (253) 798-4333.

BILLING AND PAYMENT: Patients, or their responsible legal guardians, are responsible for their accounts and are expected to pay their bill when due, whether medical insurance pays for a portion or not, including charges for evaluation, printed materials, reports, letters, consultations and telephone calls. A finance charge of 1% per month may be added to any balance not paid within 60 days after the charge was incurred. When 90 days have passed without a payment, accounts may be sent to collections and the patient or legal guardian may be responsible for any additional legal and/or collection agency charges. Results of evaluations or reports may not be released until accounts are paid in full. I understand that this is an expensive treatment and I am prepared to arrange an extended payment plan. This entails a written agreement to pay a fixed amount regularly each month until the balance is paid. If regular payments stop, the balance will be considered delinquent, and finance charges and collection procedures may be instituted.

Bills are sent out monthly and detail the dates of visits, the type of service provided, whether your insurance company had been billed for that visit, and all payments made into your account. If you have any questions about your bill please contact our billing department.

You are expected to pay for each session at the time it is held, unless we agree otherwise or unless you have insurance coverage. If you have insurance coverage you are expected to pay your co-pay at the time of each appointment. If you are uncertain about your co-pay I encourage you to contact your insurer. If you have any other questions on this matter I would suggest asking our office staff.

INSURANCE: I am a contracted provider for many, but not all, local insurance companies. You should be sure to check with your insurer and my intake office to learn whether I am a provider for your plan. You should also learn whether you need a referral or preauthorization in order to be eligible for your mental health benefit, whether you have a separate annual deductible for mental health, and whether your mental health benefit has a maximum yearly number of visits or a maximum yearly dollar amount. My billing department will submit claims to insurance companies that I am contracted with. In order for this to occur you must complete the insurance portion of the “Patient Information” form that was given to you with this office policy. You also need to provide a copy of your insurance card.

CHANGES TO THIS OFFICE POLICY: From time to time I may change the business policies described in this document. I will attempt to notify you of relevant changes

INFORMED CONSENT: your signature below indicates that you have read the information in this document and agree to abide by its terms during our professional relationship.

INFORMED CONSENT FOR ADULTS: I hereby authorize Thomas Roe Psy.D. a licensed psychologist, to render psychological
services. This authorization constitutes informed consent without exception. I have read and understand the office policy statement and notice of privacy practices and have received a copy of this office policy for myself.

* I acknowledge I have read the financial policy above and that I am responsible for all charges regardless of any insurance coverage I have. I understand that delinquent accounts may be assigned to a credit reporting collection agency and agree to pay for all legal costs and expenses including reasonable attorney fees. By signing this Acknowledgement, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding.

Please note: Rainier Behavioral Health does not provide disability evaluations or court related evaluations.

Authorized Representative or Guardian Signature (if applicable)

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