Policies

CREDIT or DEBIT CARD: A valid credit or debit card must be kept on file for the account of each client. Client understands and agrees that this card may be charged for the purposes of collecting insurance copays, deductibles, fees associated with late cancelled or missed appointments or case management.

MISSED/LATE CANCELLED APPOINTMENTS: Any appointment cancelled under 24 hours' notice is considered a Late Cancel and has an associated fee of $175.00. Any appointment the client fails to attend is considered a Missed Appointment and has an associated fee of $175.00. Missed and Late Cancel fees are not covered by insurance so the card on file would be charged. Pacific Roots Mental Health utilizes the time stamp of voice mail, text and email to determine timelines. A fee is applied because the act of scheduling an appointment creates a time commitment where the scheduled time is held in reserve exclusively for you. The standard meeting time for psychotherapy is 50 minutes. It is up to you, however, to determine the length of time of your sessions. Requests to change the 50-minute session needs to be discussed with the therapist in order for time to be scheduled in advance.

CASE MANAGEMENT: Should clients require letters pertaining to clinical work, care coordination or other case management tasks a fee of $175.00/hour, billed on the quarter hour will apply. Client must have a valid card on file to request.

DOCUMENTATION: All clinical documentation, billing and Invoices are available for free via the client portal. Should a client request printed copies of documentation, a fee of $0.79 cents per page will apply. Client must have a valid card on file to request.

MAILING: Client understands they are responsible for the cost of sending documentation via First Class Mail as well as the Case Management time associated with completion of this task. Signature required upon delivery. Client must have a valid card on file to request.

INSURANCE: All insurance must be verified by Pacific Roots Mental Health professional biller prior to Intake appointment. This process takes 1-2 business days. Once benefits have been verified, Client will be emailed with the information your insurance company provided including any copay and deductible information. Client is responsible for verifying that the information received aligns with their understanding of their health insurance benefits. Client is responsible for alerting Pacific Roots Mental Health of any changes in insurance coverage or billing information. Client understands that they are financially responsible for fees accrued in the event of insurance lapse. Card on file would be billed $175.00/session.

TELEPHONE ACCESSIBILITY: If you need to contact me between sessions, please leave a message on my voice mail. I am often not immediately available; however, I will attempt to return your call within one business day. In the event of an emergency, please call 911 or go to any local emergency room.

SOCIAL MEDIA AND TELECOMMUNICATION: Due to the importance of your confidentiality and the importance of minimizing dual relationships, I do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc.). I believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. If you have questions about this, please bring them up when we meet and we can talk more about it.

RECORDING: Pacific Roots Mental Health does not allow nor give consent to any recording, capture, recreation and or sharing of any audio, video, screen capture or digital rendering of any therapist, clinical concept, session or work product.

ELECTRONIC COMMUNICATION: I cannot ensure the confidentiality of any form of communication through electronic media, including text messages. If you prefer to communicate via email or text messaging for issues regarding scheduling or cancellations, I will do so. While I may try to return messages in a timely manner, I cannot guarantee immediate response and request that you do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies.

Services by electronic means, including but not limited to telephone communication, the Internet, facsimile machines, and e-mail is considered telemedicine. Telemedicine is broadly defined as the use of information technology to deliver medical services and information from one location to another. If you and your therapist chose to use information technology for some or all of your treatment, you need to understand that: (1) You retain the option to withhold or withdraw consent at any time without affecting the right to future care or treatment or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled. (2) All existing confidentiality protections are equally applicable. (3) Your access to all medical information transmitted during a telemedicine consultation is guaranteed, and copies of this information are available for a fee. (4) Dissemination of any of your identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without your consent. (5) There are potential risks, consequences, and benefits of telemedicine. Potential benefits include, but are not limited to improved communication capabilities, providing convenient access to up-to-date information, consultations, support, reduced costs, improved quality, change in the conditions of practice, improved access to therapy, better continuity of care, and reduction of lost work time and travel costs. Effective therapy is often facilitated when the therapist gathers within a session or a series of sessions, a multitude of observations, information, and experiences about the client. Therapists may make clinical assessments, diagnosis, and interventions based not only on direct verbal or auditory communications, written reports, and third person consultations, but also from direct visual and olfactory observations, information, and experiences. When using information technology in therapy services, potential risks include, but are not limited to the therapist's inability to make visual and olfactory observations of clinically or therapeutically potentially relevant issues such as: your physical condition including deformities, apparent height and weight, body type, attractiveness relative to social and cultural norms or standards, gait and motor coordination, posture, work speed, any noteworthy mannerism or gestures, physical or medical conditions including bruises or injuries, basic grooming and hygiene including appropriateness of dress, eye contact (including any changes in the previously listed issues), sex, chronological and apparent age, ethnicity, facial and body language, and congruence of language and facial or bodily expression. Potential consequences thus include the therapist not being aware of what he or she would consider important information, that you may not recognize as significant to present verbally the therapist.

MINORS: If you are a minor, your parents may be legally entitled to some information about your therapy. I will discuss with you and your parents what information is appropriate for them to receive and which issues are more appropriately kept confidential.

TERMINATION: Ending relationships can be difficult. Therefore, it is important to have a termination process in order to achieve some closure. The appropriate length of the termination depends on the length and intensity of the treatment. I may terminate treatment after appropriate discussion with you and a termination process if I determine that the psychotherapy is not being effectively used or if you are in default on payment. I will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. If therapy is terminated for any reason or you request another therapist, I will provide you with a list of qualified psychotherapists to treat you. You may also choose someone on your own or from another referral source.

Should you fail to schedule an appointment for three consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, I must consider the professional relationship discontinued.