Patient Services Agreement
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Welcome To my practice. This agreement contains important information about my services and business policies. Please read it over carefully, sign and date it. A copy of this agreement will be given to you upon request.
MEETINGS
The psychotherapy session is scheduled for 55 to 60 minutes. Every attempt will be made to begin and end on time.
If your scheduled appointment time needs to be cancelled, 24-HOUR NOTICE must be given [unless we both agree that you were unable to attend due to circumstances beyond your control or inclement weather]. If your time slot can be filled, you will not be charged for this appointment.
A charge of $70 will be your responsibility for failure to cancel within 24 hours or you do not appear for your scheduled time. Please note, insurance companies will not provide reimbursement for missed or late cancel appointments.
CONTACTING ME
Due to my work schedule, I am often not immediately available by telephone. When I am not available, my telephone will either be answered by the office manager or answering service and I will make every effort to return your call on the same business day. After normal business hours, and weekends and holidays, the phone service will be forwarded to the answering service. Please leave a detailed message stating the nature of your call, your telephone number(s) and the best time for a return phone call. If I will be unavailable for an extended period of time, I will provide the office manager and the answering service with the name of the colleague who will be covering for emergencies.