You have the right to end your family/child’s treatment at any time, but we do recommend at least one face-to-face graduation session with your counselor.

You have the right to ask questions on treatment with your counselor and to expect that we will work with you to meet your needs.

If your child sees a counselor individually, you have the right to expect that their counselor will communicate with you about your child’s therapy. However, to establish trust between your child and their counselor it is important for a successful therapeutic outcome, we ask you to keep in mind your child’s need for privacy.

If your child is seen in therapy, both parents may be asked to participate in the treatment. This may involve family treatment, parent meetings between you and your child’s counselor, or individual therapy for each parent. Your counselor may share information regarding issues that arise with each parent.

Therapy involves a partnership between counselor and client. Your family’s counselors will contribute knowledge, skills, and will do his/her best. The determination of success, is largely dependent upon your commitment to your family’s growth and care.

Note that our counselors, due to licensure restrictions, will seek to avoid dual relationships whenever possible, and will tend to avoid non-therapeutic relationships for some time after the client graduates from counselings.

If a court situation arises, please know it may damage the therapeutic relationship between counselor and client. The fees for any of the Solace counselors in legal matters (expert witness, therapy notes/summaries, speaking with attorneys, etc) will be billed at twice the normal hourly rate. There are many professionals able to be an expert witnesses in custody cases, divorces, or other legal situations. If necessary, we can be involved, but prefer to protect our client-counselor relationship.

Your signature below indicates that you have read and understand this information and you give permission for Solace Counseling Center to provide counseling services to you or your child. Your signature also indicates you have legal authority to consent to services provided at Solace Counseling Center.

Appointments are 45-50 minutes and your family/child’s specific hour is held by their counselor from week to week. If your family/child is unable to keep an appointment, please contact our office as soon as possible. We reserve the right to suspend counseling if two or more appointments are scheduled and not attended. We ask for you to notify the office no less than 24 hours prior to the scheduled appointment. A late or No-Show charge will be applied if not notified.

Counselors hours vary between counselors. If you need to reach your counselor, please leave a message with the office. Messages left outside of normal business hours will be returned the next business day. If you have an emergency that needs immediate attention, please seek assistance at the nearest emergency center.

Communication between you and your counselor/child’s counselor is both privileged and confidential. This means that without your written permission the counselor cannot discuss your case orally or in writing, except with members of Solace Counseling and Anxiety Center's mental health counselors and staff.

Your counselor has an ethical and legal obligation to break confidentiality under the following circumstances:

• If there is a reason to believe there is an occurrence to a child, elder or dependent abuse or neglect.
• If there is reason to believe that your child or a member of your family has serious intent to harm themselves, someone else, or property by a violent act they may commit.
• If you introduce a family member’s emotional condition into a legal proceeding or your counselor is subpoenaed to give testimony.
• If there is a court order for release of your records.

If at any time the client feels their rights have been violated or wish to file a complaint. You can reach the LPC Board at 1-800-821-3205 or by mail at Texas Behavioral Health Executive Council, 333 Guadalupe Streeet, Suite 3-900, Austin, TX 78701

Often, clients will request or initiate communication via email, text, phone calls, cloud-based platforms, or social media platforms. The counselor will carefully consider whether any such form of communication is in the best interest of the client once the client has communicated consent on this form. If the therapist finds that these forms of communication are therapeutically indicated and beneficial for the client, the counselor may respond to the client thus indicating that the communication has been considered therapeutically appropriate and beneficial for the client.

Even when communication outside of the counseling office is therapeutically beneficial to the client, it is important to recognize that no form of communication is 100% safe or protected from outside entities or unauthorized access. The counselor will take appropriate action and security precautions to prevent unauthorized access to protected health information as set forth by HIPAA. No efforts would ever be made to inappropriately break a client’s confidentiality in regard to any of these forms of communication. All other confidentiality agreements for counseling remain in full effect.

If at any point in time the counselor determines that these forms of communication are not therapeutically indicated or in the best interest of the client, the counselor may terminate electronic forms of communication. Similarly, the client has the right to terminate any or all forms of communication at any time, and for any reason.

The client understands that communication using email, text, phone call, cloud-based platforms, or social media is limited and may not be monitored. As such these forms of communication are not appropriate for emergency situations that may concern the immediate health or safety of a person and by signing below express their understanding to call emergency services in such an event.

Tele-therapy

A face-to-face counseling setting allows for in-depth communication including but not limited to non-verbals, tones of speech, clear eye contact, and other fine points of communication that are often lost in alternate forms of communication. In the case of tele-therapy some of these non-verbal cues may be lost. In these circumstances tele-therapy may be less effective than face-to-face.

All such analysis can be made with the client and the counselor together in deciding whether to engage in tele-therapy when it is deemed necessary.
While in-person if often ideal, tele-therapy may be useful in order to maintain continuity of care and employed as an option when therapeutically indicated and determined to be beneficial for the client.

Acknowledgement

By signing below I acknowledge that my therapist has reviewed the pros and cons of electronic communication with me and I understand the risks inherent to digital communication.

I also acknowledge and accept that despite precautions being taken by my counselor to maintain protected health information in accordance with HIPAA provisions, there remains some risk inherent to digital communication. I have been made aware of and accept this risk.

I further acknowledge that my therapist has reviewed the strengths and limitations inherent to tele-therapy and by signing below indicate my desire to use this service as needed.

PLEASE READ THE FOLLOWING NOTICE:

Texas law requires that prior to providing services to a minor whose parents have divorced, separated, deceased, or have been part of a custody dispute, the therapist must have a copy of the following documents prior to meeting with the child.

These documents must be provided at least 24 hours in advance before first meeting with the child and can be sent to the office.

1) A copy of the Final Divorce Decree

2) A copy of any subsequent Modifications to the Final Decree

3) If the child has been removed from their family or no longer live with their adoptive or biological parent, a copy of documents demonstrating authority to authorize treatment services is required.

Court Involvement with Minor Clients

Initial consultation session with parents will occur to ensure that counselor is a good fit for the child and the presenting situation before a counseling relationship is established with the child. If a counseling relationship is established before court involvement begins, counselor may request additional parent consultation session(s). If parents do not desire to complete the initial consultation session together, they may schedule separate consultation sessions. Consultation sessions are billed at the normal hourly rate.

Parents are expected to agree upon a regular schedule for counseling sessions, schedule those sessions, and keep those sessions. We do not allow one parent to cancel appointments made by the other, but expect that parents are communicating about their children’s sessions and schedule outside of the office. If desired, both parents can receive appointment reminders by informing the front office staff at Solace of this preference.

Both parents are considered 100% responsible for payment of all counseling services. If one parent does not pay, the other is required to pay for services. It is expected that session is paid in full at the beginning of each session. Many clients choose to leave their credit card information on file with the office so that they can be billed for their portion of the session at the time of each visit.

For a $10/session fee, within 48 business hours following each session, counselor will send an email to both parents providing a brief update about the session. Counselor will not discuss how the child feels about either parent or provide information about the other parents’ houses, etc. in these emails or in person. Emails will also be sent within 48 business hours of communication with an attorney. Parents are encouraged to email counselor any important updates or information at least 24 hours before session. It is expected that all emails between counselor and parents are sent to all 3
parties and that “reply all” is used in all communication. These emails are only to be communication between biological parents and counselor.

General Court Involvement Policies

Counseling sessions are billed at the regular hourly rate of the counselor. Should consultation with another mental health provider become necessary, time spent will be billed at the regular hourly rate of the counselor. Any work completed for court including but not limited to preparation, lawyer consultation, service of subpoenas, writing of treatment summaries, time spent in court waiting to testify, and time spent providing court testimony will be billed at double the regular hourly rate. If your or your child’s counselor is under the supervision of another mental health provider, all
court work and preparation will be billed at double the hourly rate of the counselor and the supervisor.

All subpoenas must be legally served to counselor in person by a process server with a minimum of 48 business hours’ notice before court and will not be accepted in any other form. If you or your child’s counselor is under the supervision of another mental health provider, the counselor and supervisor must both be served subpoenas in this manner.

A minimum of 3 hours will be billed at double the hourly rate for each court appearance for each mental health professional and is due in full 1 week prior to scheduled court appearance. If court is rescheduled with at least 24 hours’ notice to counselor, the 3 hour payment will transfer to the next scheduled court date. If court is rescheduled with less than 24 hours’ notice to counselor, the 3 hours billed will not be refunded or transferred. This policy applies to each individual
court appearance.