Please read this consent form carefully, as it describes the policies and procedures followed by your psychologist/therapist.
Types of Service Provided by Your Psychologist/Therapist: You will be interviewed and might be asked to fill out some questionnaires to assist in determining how best to help you. Sometimes, additional psychological testing is conducted, and the reasons for this will be discussed with you if it is relevant. Treatment usually involves individual meetings, but may also include family members or significant others in some individual sessions. All treatment will be conducted only with your consent.
What You Can Expect from Treatment: A specific, individualized treatment plan will be developed, tailored to your needs. You will often be expected to work on specific tasks outside the therapy sessions. This “homework” will be decided by you and your therapist together, and might include thinking about a particular issue, reading some relevant material, writing down a log of feelings or behaviors, or practicing a particular skill, for example. The duration of treatment is different for each person and can be difficult to estimate; your therapist will address any concerns that you have about this. If you are not feeling satisfied with your treatment for any reason, you are asked to discuss this directly with your therapist, who will work with you to uncover what might be preventing progress, will modify goals with you if appropriate, and will make a referral for you to (an)other professional(s) if necessary, and/or at your request. Sometimes people find that they have a temporary increase in their level of distress when beginning psychotherapy, because the process of working on personal issues can be difficult.
Confidentiality: What you discuss with your therapist is kept confidential, or private, with some exceptions. The therapist can, and must, break confidentiality to protect clients (such as yourself) or others in the event of emergencies such as threats of imminent harm that a client expresses towards himself/herself or others, and upon learning of any abuse or neglect of a child, a disabled person, or an elderly person. Certain information about you may also be shared with your insurance company if you choose to have insurance billed for your care. The Notice of Privacy Practices provides detailed information about how private information about your healthcare is protected and under what circumstances it may be shared.
The business name “Anxiety and Behavioral Health Services” is shared by Drs. McCreary and DeCola, each of whom maintain legally separate practices (through “limited liability companies,” or LLCs), but share certain costs to more efficiently provide services to clients. Both Dr. Braun and Dr. Free are Postdoctoral Psychology Residents employed within Dr. McCreary’s practice and are under her supervision; you will receive a separate disclosure form describing this arrangement if you see one of them. Ms. Piacquadio is an Independent Contractor in Dr. McCreary’s practice. In general, you will meet with only one of these therapists, and the notes about your sessions are private (seen only by your therapist, with the exception of therapists under supervision). However, the therapists may share information about you with each other for purposes of vacation & leave time coverage, should you need assistance from one of the other therapists when your treating therapist is not available for an extended period. When you have a session with a therapist, s/he is your therapist for that session and you will be billed by that therapist.
Fees for Services: Payments for services must be made at the time of each session. Cash, checks, and credit cards are accepted. If you choose to use a credit card for payment, you are accepting the responsibility for the credit card company learning that you are receiving services from one of the therapists in this practice, and for anyone else who sees your credit card bill learning this, as well. If you use insurance to pay for treatment, you are expected to pay any co-payment at the time of service. Should your insurance company refuse to remit payment for the services, you will be held responsible for paying the amount in full. If you do not pay your bill within 30 days of the date of an invoice, 2% interest may be added per month to the balance; in addition, if you default on your bill you may be held responsible for collection charges and/or attorneys’ fees. The following fees are charged for services:
Psychologists and Independently Contracted Therapists:
Initial Assessment Session = $225.
Therapy Session (16-37 minutes) = $95.
Therapy Session (38-52 minutes) = $140.
Therapy Session (≥ 53 minutes) = $190.
Postdoctoral Residents Under Supervision:
Initial Assessment Session = $175.
Therapy Session (16-37 minutes) = $70.
Therapy Session (38-52 minutes) = $110.
Therapy Session (≥ 53 minutes) = $130.
Phone calls will be billed directly to you, as insurance companies typically do not cover them. There is no charge for occasional, necessary phone calls (for example, regarding scheduling) lasting under 10 minutes. Calls lasting between 10-19 minutes are billed at $50; 20-29 minutes $70; 30-39 minutes at $90; 40-50 minutes at $140. In the event that a call lasts over 50 minutes, an additional $30 is charged for each additional 10-minute period.
In addition, there are out-of-pocket fees for writing treatment summary reports (for example, if you need a report sent to a psychiatrist or physician) and for reviewing records sent from other professionals. Insurance typically will not pay for these services, although they can require considerable time and effort on the part of the therapist. The fee for writing treatment reports is $150 per hour, and for reviewing records sent from other professionals the fee is $75 per hour.
Cancellation policy: You will be billed a flat fee of $60.00 if you miss an appointment without providing at least 24 hours notice. Insurance will not be billed; this is charged to you. After the third such instance, regardless of circumstances and even if you have paid the fees, your therapist reserves the right to terminate therapy and refer you elsewhere (as the lost time and income becomes significant and others who are waiting for appointments as new clients could use the appointment slots
Technology policy: Clinicians at ABHS do not connect with clientele on social media platforms such as Facebook, LinkedIn, or Twitter. If you send an invitation to connect with your psychologist/therapist on one of these media, the invitation will not be accepted. In addition, clinicians do not conduct therapy by email or text messaging. Email and text messaging are acceptable only for scheduling purposes, and only with the permission of your individual therapist. Please talk with your therapist about his/her preferences for contact, and whether or not that contact (with texts and emails, even for scheduling) is private and secure, as most email and texting platforms are not. ABHS typically provides in-person therapeutic services. A separate consent form must be signed when services are to be delivered via online video or telephone platforms.