MyersSquared LLC
Notice of Privacy Policies
Patient Consent Agreement
This patient consent agreement applies to all services provided by Myers Counseling and covers services including, but not limited to, in-person, virtual, telephone and e-visit services.
Psychological Services, Risks and Benefits: Therapy is a relationship between people that works in part because of clearly defined rights and responsibilities held by each person. As a client in psychotherapy, you have certain rights and responsibilities that are important for you to understand. There are also legal limitations to those rights that you should be aware of. I, as your therapist, have corresponding responsibilities to you. Psychotherapy has both benefits and risks. Risks may include experiencing uncomfortable feelings, such as sadness, guilt, anxiety, anger, frustration, loneliness and helplessness, because the process of psychotherapy often requires discussing the unpleasant aspects of your life. However, therapy often leads to a significant reduction in feelings of distress, increased satisfaction in interpersonal relationships, greater personal awareness, increased skills for managing stress and resolutions to specific problems. But, there are no guarantees about what will happen.
Psychotherapy also requires participation of assigned homework in between sessions. The first session will involve a comprehensive evaluation and I will be able to offer you some initial impressions of what our work might include. At that point, we will discuss your treatment goals and create an initial treatment plan. If you have questions about my procedures, we should discuss them whenever they arise. You have the right to discontinue treatment at any time and to choose a practitioner and treatment methods that best suit your needs.
Appointments: Appointments will ordinarily be 45-55 minutes in duration. The time scheduled for your appointment is assigned to you and you alone. If you need to cancel or reschedule a session, I ask that you provide me with 24 hours notice. If you miss a session without canceling, or cancel with less than 24 hour notice, my policy is to collect a no-show fee. Please note due to high demand for appointments, a late arrival will still require us to end on time.
Fees and Insurance: The standard cash fee for the initial intake is $150.00 and subsequent sessions run $125, and $100, depending on the duration. We accept some insurance plans- please ask if yours is accepted. Payment, co-pay and co-insurance is due at the time of the appointment. Each client is required to keep a credit card number on file to cover any outstanding fees (including services that insurance does not cover and cancellation fees). Your signature below indicates you give permission to charge the credit card we have on file for any outstanding balances.
Court Services: At this time we are not able to provide court testimony and any requests will have to be declined and/or squashed.
Availability/Emergencies: My general philosophy regarding emergencies is you are assumed to be self-responsible (functioning,and not in need of day-to-day supervision). As a private practitioner, I cannot assume responsibility for a client’s day-to-today functioning, nor can I be available for 24-hour per day crisis care. In the case of an emergency, please contact 911 or go to your local emergency department). Due to generally being in session with clients I may not be immediately available, but you may leave a message on my voicemail at any time and I am committed to returning calls within 24-48 hours.
Record Keeping: You will have a confidential file created in your name. Files will be maintained in a locked environment for seven years after your last appointment after which it will be shredded. Your records are also stored in a web-based electronic health record that is secure, encrypted, and HIPAA-compliant. If you have concerns regarding the treatment records, please discuss them with me. As a client, you have the right to review or receive a summary of your records at any time, except in limited legal or emergency circumstances or when I assess that releasing such information might be harmful in any way. In such a case, I will provide the records to an appropriate and legitimate mental health professional of your choice. Considering all of the above exclusions, if it is still appropriate, and upon your request, I will release information to any agency/person you specify unless I assess that releasing such information might be harmful in any way.
Social Media: Due to the confidential nature of the therapeutic relationship, I do not engage in online social networking with current clients.
Parents and Minors: While privacy in therapy is crucial to successful progress, parental involvement can also be essential. It is my policy not to provide treatment to a child under age 13 unless they agree that I can share whatever information I consider necessary with a parent. For children 14 and older, I request an agreement between the client and the parents allowing me to share general information about treatment progress and attendance, as well as a treatment summary upon completion of therapy. All other communication will require the child’s agreement, unless I feel there is a safety concern, in which case I will make every effort to notify the child of my intention to disclose information ahead of time and make every effort to handle any objections that are raised.
Termination: Ending relationships can be difficult. Therefore, it is important to have a termination process in order to achieve some closure. Therapy will end when you and I decide that your personal goals have been reached. I may terminate treatment after appropriate discussion with you if I determine that you are no longer benefiting from treatment, my experience and training are not a good match for your concerns and goals, or if you are in default on payment. You have the right to discontinue therapy at any time; however, I encourage you to discuss your decision with me so I can provide adequate referrals. If you have missed a scheduled visit and do not contact me within thirty days, I will accept that as your notice that you have terminated this agreement and that you wish to discontinue counseling. You may return to therapy in the future if you decide to continue treatment.
Complaints: If a situation comes up during the therapeutic process where you are uncomfortable in any way, please notify me immediately so that it can be discussed at that time. It is essential to have trust in this relationship. I’m here to help you process any negative thoughts or feelings that would be counterproductive to your sessions.
Confidentiality: Each and every counseling session is confidential. I am bound by law to not release any information or records without your written consent. However, the law limits this right in the following circumstances: 1. A client is a danger to self or others, 2. There is reason to suspect abuse or neglect of a child, elder, or disabled person, and 3. The court or government subpoenas records. Please also be aware that if you choose to involve insurance providers, information such as diagnosis, dates of service, and other therapeutic information will be shared.