Note: To participate in couples therapy, both individuals need to complete and sign this form. If your partner is not available at this time, they must complete and sign the Client Contract Agreement (This Form) and the Online Agreement Form prior to your first session.
In regards to minors although your sessions are still remaining in confidence parents/legal guardians will be able to request records if necessary. It is recommended as a Marriage and Family therapist to include parents and guardians in sessions periodically to help bridge and mend gaps or obstacles in communication. In cases of separation or divorce where there is joint custody it is imperative before seeing minors that both parties are in agreement and sign the contract.
Therapy does take time and it is important that you feel comfortable and heard in sessions. Initial session will consist of review of the contract, any questions you have regarding this agreement, and what issues or situations that you would like to address. A treatment plan will be put into place after the first session, regarding regular meeting times. Therapy can be terminated by you at any time, although having a final session is suggested. Breathe Easy Therapy Services LLC is willing to provide referrals for other therapists in the area if for any reason that would be necessary.
Breathe Easy Therapy Services LLC is willing to work with any clinician, family doctor, psychiatrist, school counselor, or health professional you would deem necessary to help with care. Please understand that before any collaborative care can begin there must be a Release of Information form signed off by the client. In case of 14 y.o.-17 y.o it is suggested both parent and teenager signatures are on document. You will find the Release of Information sheet listed in the document section located on the bottom of the homepage.
In an event where you need to speak outside of a session, the confidential voicemail will be available. We make every attempt to return calls within 24-48 hours. In cases of true emergency please dial 911. An emergency is defined as a serious, unexpected, and often dangerous situation requiring immediate action. Please be understanding we are not available 24/7. If an emergency transpires and you contact the confidential voicemail, there is no guarantee you will get an immediate response. Emergency services is your suggested route.
Unfortunately, there is no way that we can guarantee confidentiality on the internet. E-mail will be used only for scheduling and cancellations as this is not a confidential way of communicating. Texting will also be limited to scheduling and cancellations as well, and is not a guaranteed form of confidential communication. By engaging in these forms of communication you are stating you are aware and are bypassing these concerns.
The initial fee following the 15 minute complimentary phone consultation for service is $175.00. (This fee does not apply to group therapy participants). Any following appointments and the costs will be discussed at initial appointment. The cost will be dependent on frequency of sessions and amount of people included in the session. Payment is due at time of service by cash, check, or card made payable to Breathe Easy Therapy Services LLC unless otherwise discussed beforehand.
Services provided outside of regularly scheduled appointments such as letter writing, preparation of records or treatment summaries, extended phone consultations, and legal involvements will require separate fees. In the unusual circumstance that you are involved in a legal proceeding that requires my participation, you will be expected to pay for all professional time, including preparation and transportation costs, even if I am called to testify by another party. Because of the complexity, difficulty of legal involvement, and inability to service other clients during that time Breathe Easy Therapy Services LLC charges a separate legal fee.
Sessions will be scheduled at time of service as far in advance that works for both client and therapist. Cancellations need to be at least 24 hours in advance or a $75.00 no show fee will be charged. Not showing for any reason is subject to a 75.00 fee unless otherwise specified by the therapist. The following session will not be scheduled until the account is up to date. This is to keep slots available for any emergency clients as well as consideration for therapist’s time. In the event of an emergency or sickness please contact us as soon as possible by phone/email to avoid the $75.00 fee, open up the appointment slot to another client, and reschedule. During non-business hours i.e. Friday-Sunday email or text message is sufficient.