Appointments: Sessions are scheduled by appointment and are 80 minutes long for couples and 50 minutes for individuals. Your appointment time is reserved exclusively for you and cannot be rescheduled on short notice. Missed appointments or those not canceled more than 24 hours in advance may be billed to you for the full amount. Late cancellations due to medical or other emergencies will not be considered as missed appointments.
I am available for phone calls between sessions if needed. Calls longer than 15 minutes will require a scheduled appointment and will be pro-rated at the regular fee rate.
Couples are only seen together, unless all parties verbally agree to individual time if deemed vital to moving the work forward. Please note that I cannot hold secrets from your partner, but I can help you tell them things you might be afraid to tell them.
Fees: My fee for an 80 minute couples session is $80, and for a 50 minute individual session is $55. If these fees will prove a financial hardship to you please inquire about my sliding scale rates.
Payment & Billing Policy: You are responsible for payment for all services before or at the time of service, unless a payment plan has been arranged. Payments in advance may be paid by credit card or Pay Pal. Payments in person may be paid by check or money order. Insurance is not accepted at this time. If collections become necessary you will be responsible for all fees incurred.
Confidentiality: Communication between a counselor and clients is strictly
confidential. You must sign a release of information before any personal information can be shared with other individuals or agencies. Information may be released without your written consent only under the following legal or ethical circumstances, as outlined by law:
* When a court order is received for records or testimony.
* In the case of apparent, suspected or potential child or elder abuse/neglect.
* When clients report sexual abuse by a regulated health care professional.
* If a client indicates that s/he or another person may be a danger to his/herself or others.
Emegencies: If you are having an emergency, and need to talk to someone immediately, call 911 or one of the crisis lines listed below. If you feel you cannot keep yourself safe, go to your health plan facility Emergency Room for psychiatric evaluation.
I have read and agree to abide by the policies outlined above.
I have received a copy for my personal records.
Signature:________________________________________ Date:______________
Signature:________________________________________ Date:______________
Crisis Lines:
Multnomah County Mental Health (24 hrs): 503-215-7082
Clackamas County Mental Health: 503-655-8401
Washington County Mental Health: 503-291-9111
Portland Women’s 24/7 Crisis Line: 503-235-5333
OR Suicide & Crisis 24/7 Hotline: 503-988-4888 or 800-716-9769
Suicide Prevention Hotline: 800-422-7558
OR Child Abuse Hotline (24 hrs): 503-731-3100
Crisis Hotline for Youth & Families: 800-999-9999
Senior Helpline (24 hrs): 503-248-3646
Elder Abuse Hotline: 800-232-3020
Alcohol & Drug Helpline: 877-553-8336