PROACTIVE THERAPY, LLC : THERAPIST - CLIENT AGREEMENT
Welcome! This document contains important information about my professional services and business policies. Please read it carefully and jot down any questions you might have so that we can discuss them openly in your first session.
What do sessions look like?
The initial intake appointment is an assessment session. Once we have begun our work together, we will usually schedule one 50 minute session per week at a time we agree on, although this can vary as needed.
In our first few sessions, we will be getting to know each other and I will be conduct an assessment of your needs. We will work together to define some initial treatment goals and a plan to address your unique needs. If you have any questions about my approaches to therapy, feel free to ask them throughout the process so that we can discuss them openly. Since the therapeutic relationship is one of the predominant factors in successful therapy outcomes, I welcome your honesty if you feel that my style is not a good fit for you. I will be happy to help you set up a meeting with another mental health professional for a second opinion. In addition, since I am a private practitioner, some clients’ needs may be better addressed at a higher level of care. If this is the case, I will make every effort to assist you with obtaining the appropriate resources and referrals.
Appointments and Payment
Once we have scheduled an appointment, you are committing to attending and paying for that appointment hour.
Payment is due at the time of each session, unless we agree otherwise, or you have a third party payer that requires another arrangement. I am an in-network provider with BCBS PPO. If for some reason, your insurance company does not agree to pay for services provided, it will be your responsibility to pay any outstanding balance on those sessions. We always recommend you call your insurance company prior to seeking services in order to determine how much you will owe out of pocket per session, and if you have any deductible to meet.
I am an “out of network” provider with most other insurance companies. This means that if you would like to apply some of your out of network benefits, I can still submit to your insurance company and they may reimburse you directly for a percentage of the cost of our sessions. In this case, you will still be responsible for payment in full on the day of service. Insurance can be very confusing to navigate. Please reach out to Tory Krone, practice owner, to discuss any of your billing related questions or concerns (email@example.com).
Payment: Your credit card or HSA card that we have on file will be automatically charged after your visit. If you are in our insurance network (BCBS PPO), then this charge will be for your co-pay or deductible.
*If you plan to use an HSA card: We require a second form of payment on file in the event that your HSA account does not have sufficient funds to cover your balance. If we attempt to charge your HSA card and there is not enough to cover the balance, we will automatically charge the second method of payment on file.
If you are out of network or plan to self-pay for treatment, the following fees apply:
Intake/Assessment Appointment with Therapist: $165 - 60 minutes
Individual Therapy: $150 - 50 minutess
Group Therapy: $55 - per group
Couple’s Therapy: $175 - 60 minutes
Telephone Calls: Any phone call longer than five minutes will be charged at the regular rate ($150/50 minutes).
Letters: Should you need me to write any letters on your behalf, you will be charged a flat rate of $50 for the time required to write the letter.
Appointment Cancellation: Appointments cancelled with less than 24 hours notice will be charged $130 automatically to the credit card on file, since that hour has been reserved for you. Please note that third-party payers will not pay for a missed session. Since the cancellation policy applies regardless of the reason for your absence, consider calling me and using your session time over the phone if illness or weather prevents your presence in my office. With sufficient notice, appointments can be rescheduled. The best way to cancel or reschedule an appointment is via Email, as I check it between each session.
Here are a few reasons to commit to regular therapy sessions:
1. Get what you came for.
You decided to see a therapist for a reason.Consistency is key to reaching your goals, especially if you are not a person who wants to be in therapy for years and years. Additionally, it is vital to give yourself at least one hour a week where you can give your worries and stresses a rest and focus on YOU. If now is the time you want to work on yourself- commit!
2. Develop a stronger rapport with your therapist.
It is easier and more likely that you will become more comfortable with your therapist and more apt to opening up in the therapy session if you are meeting with him/her regularly rather than every few weeks. When we trust a person, we often allow ourselves to be more vulnerable, which is exactly what needs to happen for therapy to be effective!
3. A set, weekly time helps makes therapy an expected part of your routine.
Having infrequent or inconsistent appointments with your therapist can lead to forgetting sessions, or even the feeling that they are less important than something locked into your schedule each week. This can lead to a lack of rhythm or continuity in your work with your therapist. Continuity of care is important.
4. Avoid cancellation fees.
Therapists have cancellation policies, and if you forget your session (which is much more likely to happen when you don’t have a consistent schedule), you will end up paying for it anyway. Even if you have insurance, they will not cover the cost of a missed session or late cancellation.
5. Going to therapy even when you feel “good” can be very effective.
When we are at our best, we have more resources to deal with long standing patterns or deep personal issues than we do when we are in “crisis” mode. Although it is common for some people to feel less engaged in therapy once their acute symptoms have alleviated, more progress is often made towards longer term goals when a person feels more at his or her baseline.
You can contact our office phone: 312-626-1800 or email me at firstname.lastname@example.org. I will make every effort to return your call within one business day. If you are unable to reach me and feel that you can’t wait for me to return your call, contact your primary care physician or go to the nearest emergency room and ask for the clinician on call. In the case of emergency, please dial 911 immediately. As a private practitioner who treats many clients, I am not available for crisis intervention between sessions. If you feel that you or your child’s situation is too acute to be treated on a weekly outpatient basis, please let me know. We can discuss adding appointments or referral to a higher level of care that may be more suited to your needs. If I will be unavailable for an extended period of time, I will provide you with the name of another clinician in our practice to contact or meet with while I am away.
Due to the importance of your confidentiality and the importance of minimizing dual relationships, I do not accept friend or contact requests from current or former clients on any social networking site– except for on my professional pages (Proactive Therapy, LLC). I believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. If you have questions about this, please bring them up when we meet and we can talk more about it.
Electronic Communication I cannot ensure the confidentiality of any form of communication through electronic media, including text messages. Please note that if you choose to use email to contact me, I advise you limit the conversation to practical matters and omit clinical information as I cannot guarantee confidentiality through Email. It’s my policy to limit contact between sessions (whether via phone, email or text) to discussion of scheduling; therapeutic issues will be discussed only during a scheduled appointment.
Services by electronic means, including but not limited to telephone communication, the Internet, and e-mail are considered telemedicine by the State of Illinois. Telemedicine is broadly defined as the use of information technology to deliver medical services and information from one location to another. If you and your therapist chose to use information technology for some or all of your treatment, you need to understand that:
There are potential risks, consequences, and benefits of telemedicine. Potential benefits include, but are not limited to improved communication capabilities, providing convenient access to up-to-date information, consultations, support, reduced costs, improved quality, change in the conditions of practice, improved access to therapy, better continuity of care, and reduction of lost work time and travel costs.
When using information technology in therapy services, potential risks include, but are not limited to the therapist’s inability to make visual and olfactory observations of clinically or therapeutically potentially relevant issues such as: your physical condition including deformities, apparent height and weight, body type, attractiveness relative to social and cultural norms or standards, gait and motor coordination, posture, work speed, any noteworthy mannerism or gestures, physical or medical conditions including bruises or injuries, basic grooming and hygiene including appropriateness of dress, eye contact (including any changes in the previously listed issues), sex, chronological and apparent age, ethnicity, facial and body language, and congruence of language and facial or bodily expression. Potential consequences thus include the therapist not being aware of what he or she would consider important information, that you may not recognize as significant to present verbally the therapist.