OFFICE POLICY AND INFORMED CONSENT

Confidentiality:
The laws of the State of Illinois require that most issues discussed during the course of therapy with a psychotherapist are confidential. These laws permit you to waive the privilege of confidentiality by signing a “Release of Information Form”. However, the release of confidential materials is required in situations of suspected child abuse, of potential harm to oneself or others, and in instances where the court may subpoena records. During the course of your therapy, you may request that some information be discussed with another person (ie. your physician, spouse/partner, children, parents, etc.) If you desire that information be communicated about you to someone else, please ask for a “Release of Information Form”. If we feel that it will be useful to you during the course of your therapy, to discuss your progress or situation with another person (i.e. your physician), your therapist will request your written permission to do so and would not release that information without such written permission.

Appointments:
Therapy sessions will typically be on a weekly or bi-weekly basis. Additional appointment times can be arranged with your therapist. A therapy “hour” is 45 minutes in duration and is referred to a “clinical hour”.

Cancellations and Missed Appointments:
It is requested that you provide advance notice of cancellation at least 24 hours before a scheduled appointment. If a cancellation has not been made prior to this time, the session is a loss for someone else wishing to use that therapy time. A scheduled appointment means that it will be held only for you and, therefore, cannot be used by another person. Late cancellations, or appointments not canceled, will be billed as a “failed appointment”. Failed appointments will be billed at your regular session feel. Most insurance companies do not cover failed appointments, resulting in the client themselves being solely responsible for any such charges. If you are late, the session will still end at the scheduled end time.

Children in the Waiting Room:
We are unable to provide supervision for children in the waiting room and cannot accept responsibility for their safety if left unattended. For the safety and welfare of the children, as well as consideration for other clients and staff, please make other arrangements for childcare during therapy sessions. Parents who do not comply will risk the cancellation of their designated appointment. Parents will be held responsible for any property damage caused by their child.

Telephone Calls:
Fees are not charged for phone calls to therapists regarding appointments and similar matters. As well, fees are not charged for phone calls requiring just a few minutes. However, a pro-rated charge will be made for psychotherapy or psychotherapeutic consultations conducted over the phone that require more than 5 minutes. This would be billed at the same rate as face-to-face sessions. Phone calls may be made from our offices for emergencies.

Fees:
You will be billed for all time spent with you or on your behalf, including the therapist’s time spent preparing reports, reading letters or other documents, consultations, travel time for “out of office” services, and telephone calls. A list of all clinical fees is available by request. Payment is requested at the time of each session either by cash, check or charge card. Each client remains responsible for any fees not covered by insurance carriers.

Insurance Coverage:
If you maintain health insurance, part of your therapy expenses may be covered through that insurance. In the case of Blue Cross/Blue Shield of Illinois, PPO, or other insurance companies with whom we have a contractual agreement, however, we will honor the amount BCBSIL writes-off, and will only charge the responsible party the co-pay and deductible amount.

Returned Checks:
In the event that a check given for payment of your account is returned by your bank, a charge of $50.00 will be added to your account.

Delinquent Accounts:
Payments not made within one (1) month of the billing date will be considered late and the account charged a fee of 12% the outstanding balance. Further delinquent accounts may be sent to collections. This is typically not done unless the account is seriously overdue by 90 days. Be aware that the adult who contracts the counseling services by signing this policy and informed consent, is solely responsible for all incurred fees. A third party may be billed with their consent. If the third party does not cover the expense as outlined above, then the responsibility for payment defaults to the contracting adult.

Ethical and Professional Standards:
As professional and licensed therapists, we work diligently to uphold the most responsible, ethical and professional standards possible, and we are accountable to you. If you have any questions or concerns about your course of contact with us, please feel free to discuss these issues with us. In signing this contract you are agreeing that should you have any dissatisfaction or concern about your treatment, you will do your best to indicate your concerns to us so we can attempt to address them to your satisfaction. If you are unhappy with your services here and need help finding additional or alternative resources, we will assist you in locating a more suitable referral source.

Illinois Law for Mandated Reporting:
If information is revealed in your treatment regarding potential harm to minors or serious threat of harm to yourself or others, your therapist is required by law to report this information to the proper authorities.

Therapy May be Upsetting:
You need to be aware that engaging in psychotherapy may involve experiencing uncomfortable past traumatic events, difficult intense emotions such as depression, anger, grief, confusion or anxiety. It may also result in changes in your life that could be difficult to face. Your therapist will discuss these situations with you if they come up in the course of therapy.

Ending Therapy:
You can end therapy at any point you wish. Ending therapy is an important aspect to a successful therapeutic experience. Usually therapy pursues specific goals that you and your therapist will discuss together, including an appropriate termination process. If you decide you need to terminate your treatment prematurely, please discuss this with your therapist. Your therapist will also discuss with you if they conclude that the therapeutic process is not benefiting you. In the case where you do not discuss the termination with your therapist and have outstanding appointments scheduled, please be aware that you will be charged the set fee for the un-canceled appointment(s).