Welcome to my practice. The information provided below identifies patient’s rights and responsibilities:

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• A therapy session will last for forty-five (45) minutes.

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• Confidentiality is strictly maintained unless there is a risk to self or others as judged by the therapist.

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• If you have a crisis which needs immediate assistance and you cannot reach me, please go to your local emergency room.

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• Cancellation notice is required 48 hours prior to a scheduled session to avoid charges for missed appointments.

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• In the case of a referral to another facility or provider, information will only be released with your written consent.

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• Insurance claims will be handled by the patient. A bill will be provided at each session, or monthly, that can be used to obtain reimbursement.

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Patient History

Payment Agreement and Cancelation Policy