Welcome! This Agreement contains important information about professional services and business policies. You will also receive a document titled, “Notice of Policies and Practices to Protect the Privacy of Your Health Information,” a notice required by the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and patient rights with regard to the use and disclosure of your Protected Health Information (PHI). The law requires that your signature is obtained acknowledging that you have been provided with this information. By signing this document, you will be acknowledging that you have received the privacy notice. You will also be agreeing to the terms in this Agreement. You may revoke this Agreement at any time. That revocation will be binding unless action has already been taken in reliance on it, there are claim related obligations on me by your health insurer (as applicable), or you have not satisfied all financial obligations.
PSYCHOTHERAPY
Psychotherapy is not easily described in general statements. It varies depending on the personalities of the therapist and client(s), and the particular issues you are addressing. There are different methods and interventions I may use to help address different issues. Psychotherapy is not like a typical health care provider visit. Instead, it calls for continuous active effort on your part. For therapy to be most successful, you will have to work in and outside of our sessions. Psychotherapy can have benefits and risks. Approaching feelings or thoughts that you have tried not to think about for a long time may be painful. Making changes in your beliefs or behaviors can be scary, and sometimes disruptive to the relationships you already have. Since therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, shame, anger, frustration, loneliness, helplessness, and more. It is important that you consider carefully whether these risks are worth the benefits to you of changing. Most people who take these risks find that therapy is helpful. Psychotherapy has also been shown to have many benefits. Psychotherapy often leads to improved relationships, solutions to specific problems, and significant reductions in feelings of distress. There are no guarantees on what you will experience.
THE PROCESS OF THERAPY/EVALUATION
During our first meetings, I will assess whether I can be of benefit to you. I do not accept clients who I believe I cannot be helpful to, and if this is the case, I will refer you to others who work well with the issues you are requesting treatment for. Within a reasonable period of time after starting treatment, we will discuss my understanding of your issues, my proposed treatment plan, therapeutic objectives, and possible outcomes of therapy. I will make a clinical recommendation about what treatment will be in your best interest. Your responsibility is to make a good faith effort to fulfill the treatment recommendations to which you have agreed. If you have concerns or reservations about my treatment recommendations, I strongly encourage you to express them so that we can resolve any possible differences or misunderstandings. If during our work together I assess that I am not effective in helping you reach your therapeutic goals, I am obliged to discuss this with you and if appropriate, terminate treatment and give you referrals and recommendations who may be of help to you.
TERMINATION, TRANSITION, & FOLLOW-UP
Deciding when to stop our work together is meant to be a mutual process. Before we stop, we will discuss how you will know if or when to come back or whether a regularly scheduled “check-in” might work best for you. I recommend that we have closure on the therapy process with at least two termination sessions.
Should you request to terminate and transition to a new therapist with written permission, I am more than willing to talk with the therapist of your choice in an effort to aid the transition. I am also willing to assist you in finding another qualified therapist with whom to consult if at any time you want another therapist’s professional opinion. Failure or refusal to pay for services after a reasonable time is another condition for termination of services. Please contact me any time your financial situation changes.
RECORD-KEEPING
I keep very brief records, noting only that you have been here, diagnosis(es), interventions during session, and the minimum regarding the topics we discussed. If you prefer that I keep no records, you must give me a written request to this effect for your file and I will only note that you attended therapy in the record. Under the provisions of the Health Care Information Act of 1992, you have the right to a copy of your file at any time. You have the right to request that I correct any errors in your file. You have the right to request that I make a 3 copy of your file available to any other health care provider at your written request. I maintain your records in a secure location that cannot be accessed by anyone else.
CONSULTATION
In order to provide you with the best possible care and service, I occasionally consult with other professionals regarding my clients. Names and other information which might identify people are never mentioned so that client anonymity and confidentiality is maintained.
CONTACTING ME
Due to the nature of my work as a therapist, I am often not immediately available by telephone. While I am usually in my office during regular business hours, I do not answer the phone when I am in an appointment. When I am unavailable, my telephone is answered by confidential voice mail that I monitor frequently. I will make every effort to return your call on the same day, if not within 48 hours. If you find yourself in an urgent situation, make a judgment about the prudence of waiting for my call versus calling your primary care physician, 911, or your local 24-hour crisis line.
CANCELLATIONS AND LATENESS
Missed and canceled sessions pose some issues for both of us. First, the work of psychotherapy is sometimes challenging and when we hit a difficult place together, sometimes it can feel easier to want to avoid coming in for treatment. I would prefer we speak about this with each other openly rather than canceling sessions. It is extremely difficult for me to fill canceled sessions on short notice. If you are running late for your appointment, please call or text as soon as you can to let me know you will be late. If you are late for your session, we will still end at the regular scheduled ending time. If you do not contact me by 20 minutes into your session, I assume you do not plan to attend your session and your session time is forfeited.
CONFIDENTIALITY OF COMMUNICATION
Please be aware that e-mail, messaging using social media/internet messaging services, and text methods of communication are considered to lack the encryption necessary to ensure confidentiality according to HIPAA. Any electronic communication from these methods should be used only to set or verify appointments or for general “bookkeeping” issues. I do provide a secure, confidential messaging and email service through a HIPAA-compliant service provider upon request. Despite this, please always use caution when using communicating using the internet/phone service. Please do not contact me via text or e-mail for emergencies.
INFORMED CONSENT FOR TELEHEALTH
Therapy conducted online is technical in nature and problems may occur with internet connectivity. Internet availability may be limited and disrupted by things such as server maintenance, upgrades, or other problems (such as software or hardware malfunction). Any problems with internet availability or connectivity are outside the control of your therapist. I, your therapist, make no guarantee that such services will be available.
Disruption of video sessions due to technical complications can be resumed via telephone for the duration of the scheduled session time. If something occurs to prevent or disrupt any scheduled appointment due to technical complications and the session cannot be completed via telephone, a new appointment will be rescheduled. However, any session time utilized at or behind 15 minutes will be charged to you at a prorated amount, and you will not be charged for unused time disrupted by technical complications. Communication using a cell phone that conversation may not be secure and therefore not confidential.
Please note that there is a 24-hour cancellation policy.
Communication via www.zoom.com & the Zoom application are encrypted. Emails sent from or to personal mail accounts are automatically secure. By signing this form you acknowledge and agree that all communication of a clinical nature should be sent via a HIPAA compliant method such as discussed during online therapy sessions or methods of being encrypted/confidential.
As a rule, personal and clinical communications (i.e. communication for purposes other than scheduling) should be reserved for scheduled session time (in person face-to-face sessions, video sessions, phone sessions) except in cases of emergency. I will not respond to personal or clinical concerns via regular email or texting. Regular email nor text should not be used in the event of a crisis or an emergency. I may charge the fees set forth in the fee schedule to communicate regarding clinical services.
I will not accept my invitations to personal social media websites such as Facebook or Instagram, personal or professional networking websites such as LinkedIn, or instant messaging applications such as WhatsApp, in order to maintain client confidentiality and privacy of all parties.
You are welcome to follow public social media platforms as the information provided is specifically for public use and access, such as Healing Talks PLLC & April McElhenny, MSW, LCSW on Facebook, Tiktok, and Instagram pages.
If you need to contact me between sessions to alert me of an emergency, please call the office phone line at 210-952-5114. Your call will be returned as soon as possible. Messages are checked daily, but with less frequency at night, on weekends, and on holidays, or during scheduled vacation time, about which I, your therapist, will notify all clients of in advance. If an emergency situation arises that requires immediate attention, call the emergency National Hopeline Network at 1-800-Suicide/1-800-784-2433 or the National Suicide Prevention Lifeline at 1-800-Talk/1-800-273-8255 or dial 911. Hearing and Speech Impaired should call 1-800-799-4TTY/1-800-799-4889. In the event of a life-threatening crisis please contact a crisis hotline, call 911, or go to a hospital emergency room.
Online therapy is not a substitute for medication under the care of a psychiatrist or doctor.
Online therapy is not appropriate if you are experiencing a crisis, or having active suicidal or homicidal ideation with the intent to harm yourself or others.
Although I take substantial steps to ensure the confidentiality and privacy of therapy provided online, I cannot guarantee the security of any internet transmissions or communications. By signing this agreement you, the client, agree TO TAKE FULL RESPONSIBILITY FOR THE SECURITY OF ANY COMMUNICATIONS OR TREATMENT ON MY OWN COMPUTER AND IN MY OWN PHYSICAL LOCATION. I agree to never record or take pictures during therapy sessions. All information disclosed within sessions and the written records pertaining to those sessions are confidential and may not be revealed to anyone without my written permission, except where disclosure is required by law.