CONSENT FOR PSYCH SERVICES
CONSENT FOR PSYCHOLOGICAL SERVICES
Welcome. This form contains important information regarding my professional services and policies. Please read it carefully and make note of any questions you might have.
Psychotherapy involves the use of psychological techniques to address mental, emotional and/or behavioural problems. In my practice, I make use of techniques that have been studied scientifically and have been shown to work for most people seeking psychological treatment for a particular condition (e.g., depression, panic attacks).
You will find that my work is very focused and goal oriented. The first session will involve an assessment to help me understand the nature of your difficulties, your coping resources and strengths as well as your personal history. We will also discuss the treatment plan including the number of sessions it will likely require to achieve your goals. Most people generally begin to see improvement within the first 4 to 6 sessions.
There are several benefits to psychotherapy. These can include decreased distress, solutions to specific problems, improved self confidence, and improved functioning in important life roles.
However, there are also some risks. Given that therapy involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, anxiety, anger, guilt, or frustration. Sometimes those feelings may linger after the session. The aim of psychotherapy is to help you learn how to cope more effectively with those feelings so that they no longer overwhelm you.
There are no guarantees that treatment will work. But, if for some reason, you are not experiencing benefit within a reasonable time frame, the next step will be to discuss the options for getting your needs met.
Our initial session will be a full 60 minutes. Subsequent sessions will be 50 minutes; the remaining 10 minutes of the hour is used for necessary administrative tasks related to your treatment such as notes about the session, filling out forms, or phone calls on your behalf.
Typically, ongoing psychotherapy sessions are booked once/week. As you make progress in treatment, the sessions tend to be spaced further (once every 2- 4 weeks) in order to monitor your progress and prevent relapse.
My preference is to provide services in person. However, due to scheduling conflicts, I understand that this is not always possible. In order to provide timely ongoing service, you may have the option of seeing one of my associates by video conference over the internet once I have seen you for an initial assessment. Your therapist will meet with me once/week between your sessions to discuss your progress and plan your treatment. Hence, while you will not meet with me regularly, I will be monitoring your treatment closely on a weekly basis and will direct your treatment plan. Should you choose this option, you will still be able to speak with me directly, if needed, over the course of treatment.
Once an appointment is scheduled, whether with me or my associate, you will be expected to pay for the full amount of the session unless you provide 24 hours notice of cancellation.
I am often not immediately available by telephone. I do not answer the phone when I am with a patient. When I am unavailable to answer, you can either leave me a message on my confidential voice mail, or send me an email. I monitor both frequently and will make every effort to respond the same day.
In the case of an emergency, you should contact your family physician or proceed to the nearest emergency room.
We have agreed that my hourly fee is $200 for the initial assessment and any subsequent treatment sessions provided by me. In addition to weekly appointments, I do charge for other services you may require such as report writing, completing forms, attending meetings with other health professionals that you have authorized, and telephone conversations lasting more than 15 minutes. The hourly cost will be broken down if any additional services take less than an hour.
The hourly fee for seeing one of my associates for treatment either via video conference or in person is $150/hr.
BILLING AND PAYMENT
You will be expected to pay for each session by cash, cheque or credit card at the end of the session. An invoice will be provided to you at the end of the session that you can later submit for reimbursement by your extended health insurance provider where applicable.
In the event of a late cancellation, you will be invoiced for the full session. If the invoice is not paid within 30 days, I reserve the right to use legal means to secure payment. This may involve hiring a collection agency. In this case, I have the legal right to disclose your name, the nature of services provided and the amount due in order to collect overdue payment.