Information, Authorization, and Consent to Treatment
Welcome to NeuroBehavioral Associates
We are pleased that you selected our facility for your therapy and we are sincerely looking forward to assisting you. This document is designed to inform you about what you can expect from your therapist, policies regarding confidentiality and emergencies and several other details regarding your treatment here at Neurobehavioral Associates. Although providing this document is part of your ethical obligation to our profession, more importantly, it is part of our commitment to keep you fully informed of every part of your therapeutic experience. Please know that your relationship with your therapist or group leader is a collaborative one and we welcome any questions, comments, or suggestions regarding your course of therapy at any time.
About your therapist
Background information, theoretical views, and client participation information regarding your therapist’s educational background and experience may be found on our website under their name. It is our belief that as people become more aware accepting of themselves, they are more capable of finding a sense of peace and contentment in their lives. However, self-awareness and self-acceptance are goals that may takes a king time to achieve. Some clients need only a few sessions to achieve these goals, whereas others may require months or even years of therapy. As a client, you are in complete control and you may end your relationship with you therapist at any point. In order for therapy to be most successful, it is important for you to take an active role. This means working on the things you and your therapist talk about both during and between sessions. This also mean avoiding any mind-altering substances like alcohol or nonprescription drugs at least eight hours prior to your therapy sessions. Generally, the more of yourself you are willing to invest the greater the return Furthermore, it is our policy to only see clients who we believe have the capacity to resolve their own problem without assistance. It is out intention to empower you to your growth process to the degree that you are capable of facing life’s challenges in the future without your therapist. We also do not believe in creating dependency or prolonging therapy if the therapeutic intervention does not seem to be helping. If this is the case, your therapist will direct you to other resources that will be of assistance to you. Your personal development is out number one propriety. We encourage you to let us know if you feel that transferring to another facility or another therapist is necessary at any time. Our goal is to facilitate healing and growth and we are very committed to helping you in whatever way seems to produce maximum benefit Confidentiality and records Your communications with your therapist will become part of a clinical record of treatment and it is referred to as Protected Health information (PHI). You PHI will be kept in a file stored in a locked cabinet in our locked business office. It is filed under your first name and last initial to protect your confidentiality to the fullest extent. Additionally, your therapist will always keep everything you say to her or her completely confidential with the following exceptions (1) You direct your therapist to tell someone else and you sign a ‘Release of information form. (2) You therapist determine that you are a danger to yourself or to others. (3) You report information about the abuse of a child, an elderly person, or a disabled individual who may require protection ; o (4) You therapist is ordered by a judge to disclose information. In the latter case, you therapist’s license does not provide him or her with the ability to uphold what is legally termed “privileged communication.” Privileged communication is your right as a client to have confidential relationship with a counselor This state has a very good track record of respecting this legal right. If for some unusual reason a judge were to order the disclosure of your private information, this order can be appealed. We cannot guarantee the appeal will be sustained, but we will do everything in our power to keep what you say confidential. Please note that in couple’s counseling, your therapist does not agree to keep secretes. Information releveled any context may be discussed with either partner.
Financial Responsibility, Structure, and Cost of Sessions
Your hereby agree and accept financial responsibility for the filing of your insurance and are sole responsible for any and/or all unpaid portions of your claim filed under Neurobehavioral Associates. You agree to allow Neurobehavioral
Associates to file and accept assignment of benefits of your insurance claims on your behalf. Should your insurance deny any or part of your insurance claims, you agree to pay for your services rendered to you by Neurobehavioral Associates. Your doctor/therapist agrees to provide psychotherapy for the fee of $250 per 20-30minute session, $275 per 45-50minute session, $331 per 60-minute session and up to $331 per 60 minute (and group) therapy session, unless otherwise negotiated by you or your insurance carrier. Telephone calls that do not exceed 10 minutes in duration will be billed up to $100 per 10-minute increments. The fee for each session will be due at the conclusion of the session. Cash, personal checks, Visa, MasterCard, Discover, or American Express are acceptable for payment and we will provide you with a receipt of payment. The receipt of payment may also be used as a statement for insurance if applicable to you. Please note that there is a $35 fee for any returned checks. Insurance companies have many rules and requirements specific to certain plans. Unless otherwise negotiated, it is your responsibility to find out your insurance company’s policies and to file for insurance reimbursement. We will be glad to provide you with a statement for your insurance company and to assist you with any questions you have in this area.
Cancellation Policy
If you are unable to keep an appointment, you may notify your therapist at least 24 hours in advance. There is a $45.00 no show fee for all new patients and missed therapy appointments If such advance notice is not received, you will be financially responsible for the evaluation, interview session or testing you missed. A “No Show” fee if therapy is missed will be applied for all forensic, IUME and/or Workman Compensation in the amount of $1980 for the missed evaluation and testing. Please note that insurance companies do not reimburse for missed interviews, evaluations, sessions or testing.
In Case of Emergency
Neurobehavioral Associates is considered to be an outpatient facility and we are set up to accommodate individuals who are reasonably safe and resourceful. We do not carry beeper nor are we available at all times. If at any time this does not feel like sufficient support, please inform your therapist and he or she can discuss additional resources or transfer your case to a therapist with a 24-hour availability. Generally, your therapist will return phone calls within 24-48 hour. If you have a mental health emergency, we encourage you not to wait for a call back, but do one or more of the following Call Behavioral Health Link/GCAL: 800-715-4225 or other crisis hotline Call Augusta University at 706-721-0211 or call local hospital Call Georgia Regional Hospital 706-792-7006 or call local hospital CALL 911 Go to your nearest emergency room
Professional Relationship
Psychotherapy is a professional service we will provide to you. Because of the nature of therapy, your relationship with your therapist has be different from most relationships. It may differ in how long it lasts, the objectives or the topics discussed. It must also be limited to only the relationship of the therapist and the client. If you and your therapist were to interact in any other ways, you would then have a “dual relationship,” which could prove to be harmful to you in the long run and is, therefore unethical in the mental health profession. Dual relationships can set up conflicts between the therapists’ interest and the clients interest and then the client’s interests might not be put first. In other to offer all of our clients the best care your therapist judgements needs to be unselfish and purely focused in your needs. This is why your relationship with you therapist must remain professional in nature. Additionally, there are important differences between therapist and friendship Friends may see your potion only from their personal viewpoints and experiences. Friends may want to find quick and easy solutions to your problems so that they can feel helpful. These short- terms solutions may not be in your long-term best interest. Friends do not usually follow-up with you on their advice to see whether it was useful. They may need to have you do what they advise. A therapist offers you choices and helps you choose what is best for you. A therapist helps you learn how to solve problems better and make better decisions. A therapist's response to your situation is based on tests theories and methods of change.
You should also know that therapists are required to keep the identity of their clients confidential. As much as your therapist would like to, for your confidentiality, he or she will not address you in public unless you speak to him or her first. Your therapist also must decline any invitations to attend gatherings with your family or friends. Lastly when your therapy is completed, your therapist will not be able to be a friend to you like other friends. In sun, it is the duty of your therapist to always maintain a professional role. Please note that these guidelines are not meant to be discourteous in any way, they are strictly for your long-term protection.
Ethics, Client Welfare, and Safety
At Neurobehavioral Associates, our services will be rendered in a professional manner consistent with the ethical standards of the American Psychological Associates and/or the American Counseling Associates and/or the National Association of Social Workers and/or the American Association for Marriage and Family Therapy. If at any time you feel that your therapist is not performing in an ethical or professional manner, we ask that you please let him or know immediately. If the two of you are unable to resolve you concerns, contact Jeremy, Hertza, Psy.D. at 706-823-5250. Due to the very nature of psychotherapy, as much as we would like to guarantee specific results, regarding you therapeutic goals, we are unable to do so. However, you therapy is with you participation will work to achieve the best possible results for you. Please also be aware that changes made in therapy may affect other people in your life. Foe example, an increase in your assertiveness may no always be welcomes by others It is our intention to help you manage changes in your interpersonal relationships as they arise, but it is important for you to be aware of this possibility nonetheless. Additionally, at times people fund that they feel somewhat worse when they first start therapy before they begin to feel better, this may occur as you begin discussing certain sensitive areas of your life. However, a topic usually isn’t sensitive unless it needs attention. Therefore, discovering the discomfort is actually a success. Once you and your therapist are able to target your specific treatment needs and the particular modalities that work best for you, help is generally on the way.
Technology Statement
In our ever-changing technological society, there are several ways we could potentially communicate and/or follow each other electronically. It is our utmost importance to us that we maintain your confidentiality, respect you boundaries, and certain that you relationship with your therapist remains therapeutic and professional. Therefore we’ve developed the following policies Cell phone- is important for you to know that cell phones may be completely secure and confidential. However, we realize that most people have and utilize a cell phone. Your therapist may also use a cell phone to contact you. If this is a problem feel free to discuss with your therapist. Test messaging and email- both text messaging and emailing are not secure means of communication and may compromise your confidentiality. However, we realize that may people prefer to text and/or email because it is a way to convey information. If you choose to utilize testing or email, please discuss this with your therapist. However please know that it is our policy to utilize these means of communication strictly to confirm appointment conformations. Please do not bring up any therapeutic content via text or email to prevent comprising confidentiality. You also need to know that we are required to keep a copy of all emails and texts as part of your clinical records Facebook, LinkedIn, Instagram, Pinterest, etc. It is our policy not to accept requests from any current or former clients on social networking sites because it may compromise your confidentiality. Google- It is our policy not to search for clients on google or any other search engine. We respect your privacy and make it a policy to allow you to share information about yourself to your therapist as you feel appropriate. If there is content on the Internet that you would like to share with your therapist for therapeutic reasons, please print this material and bring it to your session.
Social Media -- Twitter, Facebook, and other
We may post psychology news on social media, our own website, or on another website or blog. If you have an interest in following any of these, please let your therapist know so that he/she may discuss any potential implications to your therapeutic relationship. Once again, managing your confidentiality is a priority We would recommend using an RSS feed or locked Twitter list which would eliminate you having a public link to our content.
In summary, technology is constantly changing and there are implications to all of the avocet hart we may not realize at the time. Please feel free to ask questions and know that we are open to any feelings or though you have about these or other modalities of communication.
Our Agreement to Enter into a Therapeutic Relationship and HIPAA Compliance form
We sincerely look forward to facilitating you on your journey towards healing and growth. If you have any questions about any part of this information, please ask your therapist.