This document will provide you with information about the therapy services I

provide, some important policies concerning my practice, and hopefully answer

any questions you may have. It will also indicate your agreement to participate

in treatment and to adhere to the policies and procedures outlined below.

 

 

Description of Services

As outlined in the consent for services I will be providing outpatient therapy

services using a combination of cognitive behavioral, strengths based, trauma

informed, and internal family systems approaches. We will work together to

identify personalized, measurable goals and the steps we will take to reach them.

I accept Mainecare but at this time remain an out of network provider for private

insurance companies.

 

My scope of practice includes counseling to develop coping skills and improve

mental health. My practice does not offer case management services,

psychological testing or evaluations, disability claims evaluations, medication

management, custody or forensic evaluations, substance abuse treatment, court

ordered treatment, or accept attorney, DHHS, or probation based referrals.

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Costs for Patients with Private Insurance

My standard rate for the initial appointment is $150 and $120 for each

appointment following the initial visit. Payment is due at the beginning of each

session. I ask that a credit/debit or HSA card be kept on file, however you are

more than welcome to use an alternative method of payment when you arrive.

My standard hourly rate would also apply in the event that I am subpoenaed to

court, whether I am called to testify or not, mainly because time away from the

office is time that I am not able to meet with clients. There are no partial charges

for sessions. If you happen to be late to a session the full session rate would still

apply.

 

If it is your intention to seek reimbursement from your insurance company for

services, it will be your responsibility to verify the following information with

your insurance company:

● Is there a deductible that must be met before receiving out of network

mental health services?

● Once I meet my deductible, what are the benefits for out of network mental

health services?

● Are there limits to my reimbursement such as a maximum amount per

session or a limit to the number of sessions I can receive?

● Are appointments through telehealth covered under my policy?

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Telehealth Appointments

 

I utilize a HIPPA compliant version of Zoom for telehealth appointments. Links

for sessions will be sent via text or email (whichever is preferable), the day prior

to your appointment. It is recommended that you have access to a private space

for telehealth appointments. Telehealth sessions cannot take place while a client

is driving or in a public space. I will be holding tele-health sessions either in my

Saco office or in my home office. Both locations are private and sound machines

will be utilized outside of the office door.

 

Ensuring Fit

In order to provide the highest quality of care, I will continuously be assessing

the clinical needs of each patient. It is possible that if new or different needs

present themselves during the course of treatment, and I feel those needs are

outside my scope of practice, I may discuss a referral to a different provider. Any

inappropriate behaviors during sessions (participating while under the influence

of any substance, verbal or physical intimidation or threats, sexualized comments

or behaviors, or otherwise unsafe behavior) will be grounds for immediate

termination of services.

 

Availability

My current office hours are Tuesdays, Wednesdays, & Thursdays 9-4:30, and Fridays

8-12. If you leave a message please know I will do my best to return your call

within one business day. Given my limited availability I am not able to provide

emergency services. If such a need arises please access your local emergency

room, call 911, or utilize the 24 hour emergency helpline by calling 888-568-1112.