Policies
Consent, Practice Policies
& Privacy
Clear expectations make room for the work. Here is how our time together is held.
Informed Consent for Psychotherapy
General Information
Therapy is both a personal and professional relationship. It is important that we establish a clear understanding of how our work together will proceed, including expectations, responsibilities, and boundaries. Please review this document carefully and discuss any questions with me before signing.
The Therapeutic Process
Therapy can bring both benefits and challenges. At times, you may experience strong or uncomfortable emotions such as sadness, anxiety, frustration, or anger as you explore past and present experiences. Therapy also often brings relief, insight, improved relationships, and healthier coping strategies. While I cannot guarantee outcomes, I will provide my best professional effort, support, and care.
Confidentiality
All information shared in therapy is confidential, with exceptions required by law, including:
- If you present a serious risk of harm to yourself.
- If you threaten serious harm to another person.
- If I suspect child abuse, elder abuse, or abuse of a person with a disability.
- If ordered by a court of law with a valid subpoena.
- As otherwise required under the Illinois Mental Health and Developmental Disabilities Confidentiality Act or federal HIPAA law.
I may occasionally consult with other professionals to ensure quality care, but your identity will not be revealed. If we encounter each other outside of session, I will not acknowledge you unless you initiate contact, in order to protect your privacy.
Practice Policies
Appointments and Cancellations
- Sessions are typically 50 to 55 minutes.
- Individual sessions: $190. Couples sessions: $220.
- If you need to cancel or reschedule, please provide at least 24 hours of advance notice.
- Cancellations or missed appointments with less than 24 hours of notice will be charged a $150 fee, not billable to insurance.
Communication
- Phone calls: I return calls within 24 hours when possible. Calls over 15 minutes may be billed at the session rate.
- Email: For scheduling purposes only. Please do not use email for clinical matters.
- Text messaging: Not permitted for clinical communication. Texts may be used only for brief logistical updates, such as late arrival.
- Emergencies: If you are experiencing an emergency, please call 911 or go to the nearest emergency room.
Social Media and Boundaries
To maintain confidentiality and professional boundaries, I do not accept friend or contact requests from current or former clients on social media.
Telehealth
Therapy services may be provided via secure, HIPAA compliant video platforms. By engaging in telehealth services, you acknowledge:
- You may withdraw consent for telehealth at any time.
- The same confidentiality protections apply.
- Telehealth has benefits, such as convenience and access, and limitations, such as the lack of physical observation.
- You are responsible for securing a private location and stable internet connection.
Insurance and Payment
- If you use insurance, you are responsible for copays, deductibles, and any non-covered services.
- If claims are denied, you are responsible for payment.
- Payment is due at the time of service unless otherwise arranged.
Termination of Therapy
Ending therapy is an important part of the process. If you wish to end therapy, we will work together on a termination plan. I may also recommend termination if therapy is not being effectively used, or in cases of repeated non-payment. If you do not attend sessions for three consecutive weeks without notice, the professional relationship may be considered ended.
Complaints
If you have concerns, please discuss them with me directly. If you believe I have acted unethically, you may file a complaint with the Illinois Department of Financial and Professional Regulation (IDFPR), Clinical Social Work Licensing Board:
- Website: idfpr.illinois.gov
- Phone: 1-888-473-4858
You may also contact the U.S. Department of Health and Human Services regarding HIPAA rights. I will not retaliate against you for filing a complaint.
Notice of Privacy Practices (HIPAA)
This notice describes how your health information may be used and disclosed, and how you can access it.
My Responsibilities
I am required by law to:
- Maintain the privacy of your protected health information (PHI).
- Provide you with this notice of privacy practices.
- Comply with the terms of this notice.
How I May Use and Disclose Your PHI
- For treatment, payment, and health care operations, such as coordination of care and billing.
- As required by law, such as reporting abuse or by court order.
- For your safety or the safety of others.
- For public health purposes, research, and oversight activities, when legally permitted.
Uses Requiring Your Authorization
I will not release psychotherapy notes, use your PHI for marketing, or sell your PHI without your written authorization.
Your Rights
- Request limits on how your information is used or disclosed.
- Request confidential communication, for example contact by mail only.
- Inspect and receive a copy of your record, excluding psychotherapy notes.
- Request corrections to your record.
- Receive a paper or electronic copy of this notice.
Ready to begin
Consent for treatment is reviewed and signed through the secure client portal before your first session. If anything here raises a question, bring it to our consultation. Nothing gets signed before you understand it.