Behavioral Health services are based on a relationship between people that works partly because of clearly defined rights and responsibilities held by each person. You have a right to understand the evaluation and treatment procedure being used with you. It is important to be an informed and knowledgeable client and it is always appropriate to ask questions about your counselor, his or her therapeutic approach, and your progress with the evaluation and/or treatment process. You are free to stop behavioral health services at any time.

It is often helpful to have a written copy of office policies that you may refer to at any time. This document contains important information about my professional services and business policies. If you have any questions after reading this form, please feel free to discuss them with me before signing.

Approach to Counseling
Using Gestalt therapy, which focuses on experiencing thoughts and beliefs, is one method of therapy I believe in. Processing feelings is usually not easy, and therefore difficult to communicate. This is an effective approach when working with depression, anxiety, anger, trauma, grief, divorce, self concept, and much more. I also take portions of Dialectical Behavioral Therapy and Cognitive Behavioral Therapy to use with clients with personality disorders, chronic pain, depression, anxiety and phobias, and academic issues.

When working with a family, I utilize the Family Systems Theory. This theory's premise views everything that happens to any family member has an impact on everyone else in the family. All family members are interconnected and therefore, choices and experiences effect the whole system. This coincides with the idea that marital problems, divorce, and other issues which effect an adult, will in turn, effect the child.

Play Therapy is used quiet often for children. Anger, depression, abuse, and grief are explored in a non-judgmental, accepting environment where a child can feel safe to explore their inner feelings. Sandtray or sandplay is also used for children and adults.

I can also provide counseling from the Christian perspective.

*Responsibility for change resides with the client with our role being that of information provision, insight reflection, and social support. You should note that therapy produces changes and may unleash strong feelings. You need to be aware of the potential strains on yourself and your relationships which may occur during therapy.

Confidentiality
Naturally, I will need to know a great deal about you. Except for the situations described below, you have the right to privacy during our work together. Everyone at our office involved in your care is aware of the importance of confidentiality. Nearly all issues discussed in the course of treatment are strictly confidential. I cannot share any information about our work together without your prior written permission, except in the circumstances outlined below. You may direct us to disclose information with whomever you choose, and you can change your mind and revoke that permission at any time.

You may ask anyone you wish to attend a therapy session with you, but let me know in advance so I can decide what information, if any, you want to be kept confidential during that session. If you are participating in couples or family therapy, please be aware that both you and other individuals in therapy with you are considered to be the "client." It is my policy to openly discuss and agree on how information you provide me individually will be managed. In most cases, I believe it is best to avoid secrets among participants.

It is important that you fully understand the limitations of confidentiality in order for you to make an informed decision regarding what you tell us. By law, I am required to disclose confidential information to the appropriate persons and/or agencies if any of the following conditions exist:


I evaluate you to be a danger to yourself or others.
You are a minor, elderly, or disabled and I believe you are the victim of abuse or if you divulge information about such abuse.
You are involved in legal proceedings in which the court subpoenas your mental health records.
You waive your rights to privilege or give consent to disclosure of information.

If you are here on the advice of your attorney, which is most likely the case, you will sign consent for release of information, and a lot of what is said, or at least a summary, will probably be needed for the purpose of your custody case. If you are not okay with this, please let your attorney know. You are probably here so that in the future I can testify to what you tell me and give my clinical observations and thoughts to the court, under a subpoena.

Minors
If you are under 18 years of age, please be aware that the law may provide parents with the right to examine your behavioral health records. Because psychotherapy requires trust and privacy to work effectively, it will be important for the therapist, parent(s), and minor to agree on how information will be exchanged during the course of treatment. With adolescents, the clinical goal is typically to maximize privacy, with the exception of issues that compromise the physical safety of the minor. Parents/guardians will be provided with general information on how treatment is proceeding. Before giving parents/guardians any information, I will discuss the matter with the minor and will do my best to resolve any objections the minor may have about what I am prepared to discuss. If it is detrimental to the relationship with the minor, I reserve the right to keep that information confidential. However, please understand, I will never keep anything from the parents that may harm the child presently or in the future. I also abide by the Code of Ethics.

Record-keeping
I normally keep brief records, noting your participation and a brief discussion of what occurred during our session. You have a right to review your mental health record and to correct any errors in your file. You can request in writing that I send information to any other health care provider. Legally, raw testing data can only be sent to a licensed psychologist. I maintain your records in a secure location to protect your privacy.

Diagnosis
Normally, if a third party (i.e., insurance company) is paying for part of your bill, they may require a formal diagnosis as a condition of payment. Diagnoses are technical terms to describe the nature and severity of your problems. However, since I do not bill an insurance company, a diagnosis is not necessary for payment. If I use a diagnosis, I will discuss this with you. I DO NOT BILL INSURANCE THROUGH SERENDIPITY RESOLUTIONS & COUNSELING.

Fees
The full fee is collected at the beginning of each session unless other acceptable arrangements have been made in advance. I will make every effort to keep the number of your visits to a minimum. In general, the number of sessions you require and the length of each session will depend on the issues you are working on, the amount of between-session effort you put into your therapy goals, and the complexity of the problems. In unusual circumstances, you may become involved in litigation that may require my participation. You will be expected to pay for the professional time required even if am compelled to testify by another party. In addition, there may be charges for:

Administration, scoring, and interpretation of any psychological tests.
Reports, letters, or extended consultations on behalf of clients to physicians, agencies, employers, etc.
Phone calls to reschedule will not be billed, but between-session phone calls will be charged $50 per every five minutes.

The initial diagnostic interview it is $175, and thereafter my fees are $150 per hour for individual counseling, $175 for family counseling, which is 45 minutes, including, but not limited to, individual therapy (45 minutes), behavioral health testing and report writing (per hour), and consultation with approved parties. I will be happy to discuss fees for your particular service(s) with you. Couples and families, especially in litigation, or under "Parent Facilitation" are  $175-$225 per 45-60-minute session. Saturdays appointments, when available are $175.

Please be aware that unpaid accounts may be referred to an outside agency for collection if outstanding for more than 60 days. However, this action will only be taken as a last effort to collect fees after other means of collection have been unsuccessful. No clinical information will be shared with the collection agency in this effort.

No-show/Cancellation Policy
When you schedule an appointment with us, I am committing an hour of my time to your care. During that hour, you can expect my full and uninterrupted attention. As such, I require a 48-hour notification of cancellation if you need rescheduling consideration (cancellations for Monday must be given on Thursday). Any appointments canceled less than 48 hours in advance, and any appointments for which you no-show, which means I cannot fill the time slot for the needs of other clients; therefore, late cancellation and no-shows will be billed to you at my full hourly rate.

Drug or Alcohol Use Policy
Alcohol and drugs cloud judgment and reasoning abilities, and as such are counterproductive to therapy. Should I discover that you are under the influence of drugs or alcohol when you come in for therapy, the session will be immediately terminated and you will be billed at my full hourly rate for that session.

Insurance
Again, I do not accept any insurance for any services. All services must be paid, in advance, with cash, check, or money order. If a check bounces, you will be responsible for the fees, plus $30, and you will not be rescheduled until the balance is cleared.

Emergencies and Phone Calls
I can generally be reached by phone (210.241.2591) from 8:00 A.M. to 5:00 P.M., Monday through Friday, should you need to contact me for any reason. Please leave me a voice mail message and I will make every effort to return your call on the same day you make it. I cannot guarantee my availability outside of regular business hours in the event of an emergency. If an emergency arises, I ask that you seek help immediately from your physician or a hospital emergency room. IF YOU ARE UNABLE TO MAKE IT TO THE HOSPITAL, CALL 911. University Hospital (210.358.2524), 4502 Medical Drive in San Antonio, has psychiatric care available in the emergency room at all times, as do most other community hospitals.

Ethics and Professional Standards
As licensed professional counselors, I am regulated by the Texas State Board of Examiners of Licensed Professional Counselors and area accountable for our work with you. The number for the Texas State Board of Licensed Professional Counselors is 66369. If you have any concerns about the course of evaluation or treatment, please discuss them with me. I look forward to working with you.

Sessions will be at the following locations, unless otherwise noted:
12030 Bandera Road, Suite 108, I, Helotes, TX 78023 (at the Synergy Business Center Office)

Please remember, if this is court-ordered, or there is the possibility of going to court, not all that is discussed is confidential. This will be reviewed multiple times during this relationship, whether it is as a parent to a child client, a client, as a Parent Facilitator, Coordinator, or in Contested Case Evaluations. Most of these relationships have additional paperwork to sign.