since 1996, working with children, individuals, couples, groups and families. Therapist’s theoretical orientation can be described as Cognitive-Behavioral and Family System approaches.
any third party without written authorization from Patient, except where required or permitted by law. Exceptions to confidentiality, include, but are not limited to reporting child, elder and dependent adult abuse, when a patient makes a serious threat of violence towards a reasonably identifiable victim, or when a patient is dangerous to him/herself or the person or property of another.
manage care organization, or any other third party mayor. Patient is responsible for verifying and understanding the limits of his/her coverage, as well as his/her co- payments and deductibles. Therapist is a contracted provider with the following companies: Aetna, Blue Cross of California, Blue Shield of California, Health Net, Magellan, ComPsych, Managed Health Network (MHN), PacifiCare Behavioral Health (PBH), United Behavioral Health (UBH)/ U.S. Behavioral Health Plan California (USBHPC), ValueOptions, NEAS (EAP Program), other various insurances, and has agreed to a specific fee. If patient intends to use benefits of his/her health insurance policy, Patient agrees to inform Therapist in advance.
session. Session longer than 50-minutes are charged for the additional time pro rata. Therapist reserve the right to periodically adjust this fee. Patient will be notified of any fee adjustment in advance. In addition, this fee may be adjusted by contract with insurance companies, HMOs, managed care organizations, or other third-party payors, or by agreement with Therapist. Patient is expected to pay for services at the time services are rendered. Therapist accepts cash and checks. Patient may also pay by major credit cards (Visa, Master, American Express and Discover Card).
members, discuss a myriad of issues, events, experiences and memories for the purpose of creating positive change so Patient can experience his/her life more fully. It provides an opportunity to better, and more deeply understand oneself, as well as, any problems or difficulties Patient may be experiencing. Psychotherapy is a joint effort between Patient and Therapist. Process and success may vary depending upon the particular problems or issues and being addressed, as well as many other factors. Participating in therapy may result in a number of benefits to Patient, including, but not limited to, reduced stress and anxiety, a decrease in negative thoughts and self- sabotaging behaviors, improved interpersonal relationships, increased comfort in social, school, and family settings, and increased self-confidence. Such benefits may also require substantial effort on the part if Patient, as well as his/her caregiver(s) and /or family member(s), including an active participation in the therapeutic process, honestly, and a willingness to change feelings, thoughts and behaviors. There is no guarantee that therapy will yield any or all of the benefits listed above. Participating in therapy may also involve some discomfort, including remembering and discussing unpleasant events, feelings, and experiences. This discomfort may also extend to other family members, as they may be asked to address difficult issues and family dynamics. The process may evoke strong feelings or sadness, anger, fear, etc. There may be times in which Therapist will challenge the perceptions and assumptions of the Patient or other family members, and offer different perspectives. The issues presented by Patient may result in unintended outcomes, including changes in personal relationships. During the therapeutic process, many patients find that they feel worse before they feel better. This is generally a normal course of events. Personal growth and changes may be easy and swift at times, but may also be slow and frustrating. Patient should address any concerns his/she has regarding his/her progress in therapy with Therapist.
regarding Patient’s treatment. These notes constitute Therapist’s clinical and business records, which by law, Therapist is required to maintain. Such records are the sole property of Therapist. Therapist will not alter his/her normal record keeping process at the request of any patient or representative. Should Patient request a copy of Therapist’s records, such a request must be made in writing. Therapist reserves the right, under California law, to provide Patient or Representative, with a treatment summary in lieu of actual records. Therapist also reserves the right to refuse to produce a copy of the record under certain circumstances, but may, as requested, provide a copy of the record to another treating health care provider. Therapist will maintain Patient for ten years following termination of therapy. However, after ten years, Patient's records will be destroyed in a manner that preserves Patient’s confidentiality.
Patient is also responsible for payment of the agreed upon fee for any session(s) for which Patient failed to give Therapist at least 24 hours notice of cancellation.
termination include, but not limited to, untimely payment of fees, failure to comply with treatment recommendations, conflicts of interest, failure to participate in therapy, Patient needs are outside of therapist’s scope of competence or practice, or Patient is not making adequate progress in therapy. Patient has the right to terminate therapy at his/her discretion. Upon either party’s decision to termination therapy, Therapist will generally recommend that Patient participates in at least one, or possible more, termination session (s). These sessions are intended to facilitate in a positive termination experience and give both parties an opportunity to reflect on the work that has been done. Therapist will also attempt to ensure a smooth transition to another therapist by offering referrals to Patient.
or other caregiver(s) are supportive of the therapeutic process. Therapist generally requires the consent of both parents prior to providing any services to a minor child. If any question exists regarding the authority of Representative to give consent for psychotherapy, Therapist will require that Representative submit supporting legal documentation, such as a custody order, prior to the commencement of services. Therapist will not voluntarily participate in any litigation, or custody dispute in which Patient, or Representative, and another individual, or entity, are parties. Therapist has a policy of not communicating with Representative’s attorney and will generally not write or sign letters, reports, declarations, or affidavits to be used in Patient’s, or Representative’ s, legal matter. Therapist will generally not provide records or testimony unless compelled to do so. Should Therapist be subpoenaed, or ordered by a court law, to appear as a witness in an action involving Patient, Representative agrees to reimburse Therapist for any time spent for preparation, travel, or other time in which Therapist has made him/herself available for such an appearance at Therapist’s usual and customary hourly rate of USD $120.00 . In addition, Therapist will make efforts to be uninvolved in any custody dispute between Patient’s parents. The information disclosed by Patient, as well as any records created, is subject to the psychotherapist-patient privilege. The psychotherapist-patient privilege results from the special relationship between Therapist and Patient in the eyes of the law. It is akin to the attorney-client privilege or the doctor-patient privilege. Typically, the patient is the holder of the psychotherapist-patient privilege. If Therapist receives a subpoena for records, deposition testimony, or testimony in a court of law, Therapist will assert the psychotherapist-patient privilege on Patient’s behalf until instructed, in writing, to do otherwise be a person with the authority to waive the privilege on Patient’s behalf. When a patient is a minor child, the holder of the psychotherapist-patient privilege is either the minor, a court appointed guardian, or minor’s counsel. Parents typically do not have the authority to waive the psychotherapist-patient privilege for their minor children, unless given such authority by a court of law. Representative is encouraged to discuss any concerns regarding the psychotherapist-patient privilege with his/her attorney. Patient, Representative, should be aware that he/she might be waiving the psychotherapist-patient privilege if he/she makes his/her mental not emotional state an issue in a legal proceeding Patient, or Representative, should address any concerns he/she might have regarding the psychotherapist-patient privilege with his/her attorney. Copy Right 2006 @ arcadiafamilytherapy.com |
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Arcadia, CA 91006
(626) 236-2887
(626) 236-2887