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How is Confidentialitry Handled?
Confidentiality refers to your expectation about privacy concerning information you disclose during your sessions. I will, and must, hold in confidence all that is disclosed, including the fact that you have consulted with me. There are, however, situations where Virginia law requires me to comply with certain regulations, as follows:
1) If I have reason to suspect that child abuse has occurred, the Commonwealth of Virginia requires that it be reported to the Department of Social Services. Should such a report become necessary, I will try my best to discuss this with you first. Child abuse includes neglect of medical needs, abandonment, sexual exploitation and physical or mental injuries that result in impaired functioning.
2) If I believe that you are in clear or imminent danger to yourself or another person, I am required by law to notify others to prevent that occurrence.
3) In a legal proceeding, client-therapist communications are privileged: a) only for civil actions, b) only for individual therapy, not couple, family, or group sessions, c) unless your mental status is an issue before the court, d) unless the court, in the sound exercise of sound discretion, deems such disclosure necessary to sound administration of justice.
How are Fees Handled?
The payment of fees is expected at each session. In the case of an inability to pay on the day of service, please be sure that the fee is paid before the next session.
I will give you a monthly statement each month which you may want for insurance or tax purposes. This bill should be sufficient for submission to your insurance carrier. If, however, a more elaborate form is necessary for your insurance carrier which requires more than 30 minutes of my time to complete, there will be a fee charged, comparable to my hourly fee. This situation is not common, however, and when applicable, will most likely only be a quarterly event at the most.
When an insurance company contacts me for information regarding your coverage, it is apparently understood by them, that by your enlisting their insurance services that you have already signed a release of information which allows me to release information to them so that you may receive reimbursements. I, however, would like a signature directly from you stating such (see last page).
There will be a $30 charge for the return of a check from the bank.
Are you involved with Managed Care or on any Provider Panels?
I am not a participant with any managed care insurance companies because I disagree philosophically with the idea that treatment (length and type) should be determined by a third party, whose primary interest is the containment of costs, and not what might be best for you.
It is important for you to know that if you have coverage with one such insurance company, that they will request every detail that I may have about you that will be useful in determining not only whether you need treatment, but how much and for how long.
I am willing to fill out the necessary forms in order for you to get the coverage which you deserve, but it is important for you to know that you and I will be the parties to decide your treatment, length, and type, which will be entirely based on your needs.
How do you deal with Cancellations?
Your appointment time will be reserved for you especially, and as such, I will expect that you will be there. Unless I have been notified of the cancellation at least 48 hours in advance, you will be charged for that session, just as renters are charged rent for the use of space. An exception to this will be if I have to cancel an appointment, in which case there will be no charge to you. In the event that I would be late, the time will be made up at the end of the session.
In the event of inclement weather, the 48 hour cancellation policy is waived to the extent that weather is not always predictable and I would expect a phone call to discuss your level of comfort in driving in bad conditions, so that a decision can be made regarding coming to the appointment. You can expect that I will make every effort to be there, but if it looks like you cannot make it. I expect a timely call indicating otherwise (within 2 hours of scheduled appointment, if possible).
What is the usual session length and frequency?
The length of each individual counseling session is fifty minutes long. Generally, the ideal frequency of sessions is once or twice a week, depending on your needs.
For groups, the length of each session is one hour and fifteen minutes. Some groups meet weekly, others meet twice monthly.
What about Vacations and/or Absenses?
I will try to give you at least one month’s notice of when I plan to be away on vacation or work conferences. I will always leave the name and number of a fellow therapist, should you need to speak or meet with someone during these times.
How can I reach you by phone?
You can reach me by using my phone number (703) 608-0180. I check messages between 8 AM and 10 PM. If you have an emergency and need to reach someone immediately, call 911 or go to your nearest Emergency Room. I will return your call as soon as I can.
Generally, phone calls should be limited to changes in schedules, cancellations, or other logistical matters. Should other matters come up for you, it is best to wait to discuss these in our sessions.
Can you prescribe medication?
Since I am not a physician and cannot prescribe medication, I can give you name of psychiatrists who do. There may be circumstances, either in the beginning of our work or during the course of our work, in which I feel it would be imperative for you to get evaluated for medication, in order for our work to continue. This situation would be one in which I felt your condition was life threatening.
How long will therapy take? When will I know I'm finished?
Termination is the ending phase of our work together. I stress the word “phase” because it is just that. It is a phase of therapy during which many issues come up- some old, some new-that also need to be worked through as part of the termination. Many times throughout the course of therapy, you may be tempted to terminate prematurely. Usually you will find at these times, that an obstacle has come up for you that may appear to be one that cannot be overcome. it is at these points in therapy that are, paradoxically, the most fruitful, so it is important to give them equal time and focus in our work, so that they can be worked through.
At the end, there will come a time, different for everyone, when we both concur that termination is imminent. When that time has come, termination will have been a mutual decision.
What would happen if something happened, and you were unable to work?
In the event of my death or incapacitation, you can contact Wendy Fischer LCSW to meet with either individually or to reconvene group sessions. Her office is located at 5021 Seminary Road in Alexandria, Virginia, and her phone number is 703-866-4565.
CLIENT SIGNATURE FORM
CLIENT ______________________
DATE_________________
Signature______________________
Address _______________________
_______________________
_______________________
Date of Birth___________________
Phone No. (Home)_______________
(Work)__________________
Emergency Contact____________________________________
(Name and phone number)
Referral Source__________________
Insurance Company______________
Insurance Release of Information
_______________________________
(Signature)
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