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This document, referred to as the Agreement, details important information about our professional services and business policies. It also includes a summary of the Health Insurance Portability and Accountability Act (HIPAA), a federal law ensuring privacy and patient rights regarding the use and disclosure of your Protected Health Information (PHI) for treatment, payment, and health care operations purposes. We will provide you with a Notice of Privacy Practices, attached to this Agreement, which further explains HIPAA and how it applies to your personal health information.
Reading these documents carefully is crucial, and we welcome any questions you may have about our procedures. By signing this Agreement, you acknowledge receiving this information and agree to the terms set forth. This Agreement can be revoked in writing at any time, with certain conditions as outlined herein.
Psychotherapy at Mindful Connections Psychological Services, PLLC is tailored to individual needs and varies based on the psychologist and client dynamics. It requires active participation, both during sessions and outside. While therapy can lead to numerous benefits like improved relationships and reduced distress, it may also involve discussing uncomfortable life aspects, potentially leading to temporary feelings of discomfort.
Initial sessions will focus on evaluating your needs, followed by a discussion of treatment plans and methods. Selecting a therapist is a significant decision, and we encourage open dialogue about any concerns or questions you might have.
Our evaluations typically span 2 to 4 sessions, helping determine if our services align with your goals. Regular sessions are usually scheduled weekly for 45 minutes, though this can vary. Please note that appointments canceled without 24 business hours’ notice are charged, and insurance companies generally do not reimburse for missed sessions.
Our standard session fee is $160, applicable to various services provided. We also charge for additional services like report writing, extended phone consultations, coordination with other professionals, and legal involvements. Detailed fee structures for these services will be provided.
Due to varying work schedules, immediate telephone availability may not be possible. Our office staff, available Monday through Friday from 8 am to 6 pm, will assist with messages. For urgent needs, please contact your family physician or nearest emergency room. In the psychologist’s extended absence, a colleague’s contact will be provided.
Confidentiality is a cornerstone of our practice, yet there are specific instances where disclosure is required or permitted by law, such as imminent harm to self or others, legal proceedings, or health oversight activities. We adhere to HIPAA regulations and ensure that any disclosure is minimal and necessary.
We maintain two sets of records: the Clinical Record and Psychotherapy Notes. Access to these records is governed by HIPAA and state laws, and we encourage discussion of any concerns about accessing these records. HIPAA also provides rights regarding record amendments, disclosures, and receiving copies of records and policies.
For patients under 18, laws concerning access to treatment records by parents vary. We prioritize confidentiality, particularly with teenagers, and typically provide only general treatment progress information to parents, barring any safety concerns.
You are expected to pay for each session at the time it is held unless alternative arrangements are agreed upon or insurance coverage dictates otherwise. For other professional services, payment schedules will be agreed upon when requested. Overdue accounts beyond 60 days may necessitate legal actions for payment recovery, involving only the necessary disclosure of treatment details.
Understanding your insurance coverage for mental health treatment is crucial. While we assist in form processing and advocating for your entitled benefits, you are ultimately responsible for the payment of our fees. It’s essential to be aware of your insurance policy’s mental health services coverage. Managed Health Care plans like HMOs and PPOs often have specific requirements and limitations for therapy coverage.
Our practice, Mindful Connections Psychological Services, PLLC, is committed to providing you with quality psychological services. We look forward to working with you and are available to discuss any aspect of this Agreement and our services at your convenience.
Embrace a journey of healing with Mindful Connections. With your internal resources and our clinical support, we will work to establish secure and nurturing relationships by fostering balance and renewal in your life.
We offer holistic therapy aimed at achieving physical and emotional balance.
We accept multiple health insurance plans, please visit our Frequent Ask Questions (FAQ) page for more information.