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Pre-Note: You are always welcome as we are going through this document to clarify in any way necessary what a term or phrase looks like “in practice”. I am also happy to provide verbal and/or written definitions of terms. Terms are also defined in other intake documents you will review and sign prior to our treatment.
I believe that clear and mutual understandings of processes and expectations within the context of therapy is vital, which is one part of why I provide and review this document with all potential clients.
Additionally, therapy is an intentional and ongoing commitment. It is also an agreement between us that you and I will have a reserved time, specifically held and honored for you. Given that I maintain a number of specialized areas of experience and expertise, developed over the course of many years, and that I work with many specialized populations, it is important for me to provide competent and intentional care in the most ethical, supportive, and appropriate manner I am able. This includes mutual understandings around what time, commitments and expectations will be within our work together, and having explicit and honest conversations about our capacity to make these commitments in a given time period is a very important part of this. This philosophy and these values have shaped the below policies, and are what allow me to support the greatest number of clients at my most competent level of performance - you and your ability to get the best care possible are the most vital concerns that I have.
The following points are what you can expect in terms of requirements around attendance, time, and the establishment of therapy.
* Initially, upon a first (1st) session, we will review the items on this list together. At that time, we can address any concerns, any need for clarification, and address any other relevant areas which are important to you and/or I.
Yes, I understand and agree
No, I do not agree
* At our third (3rd) session, we will both discuss the way treatment has felt so far, how we are each feeling about the fit and suitability of my skillset and approach with your needs, hopes, and care desired/required. Either of us at that point may discuss the option of helping you transition care to another provider.
Yes, I understand and agree
No, I do not agree
NOTE: When insurance is involved, I will do my best to connect you with therapists who take that insurance. However, when this is not possible I will offer to help you call your insurance to demand that you receive the legal rights you have to competent and timely access to mental health care in California, which all insurance plans are legally obligated to meet.
* After one (1) no show/no contact/no timely response to a session, we will discuss the reasons for it at our next meeting.
Yes, I understand and agree
No, I do not agree
* If the next meeting after a no show is cancelled or not attended (such as a second no show/no contact), we will discuss termination/transition of care.
Yes, I understand and agree
No, I do not agree
* After three (3) no shows/no contact/no timely response events - regardless of how close together or how far apart they are - I will initiate ending this cycle of therapy and/or attempt to support you in transition of care. There are very few exceptions to this, but if you want to discuss it we can always do so.
Yes, I understand and agree
No, I do not agree
* In the case of two (2) or more late cancellations (defined as cancellations with less than 47:59 hours - in other words, less than 48 hours - before our scheduled appointment time) in ANY four (4) week timespan, we will have a discussion around scheduling, barriers to care, the experience of therapy as a whole, and whether or not it is possible to change treatment in such a way as to support your needs, or to end this cycle of therapy/transition care. These discussions will be based heavily, if not entirely, around context and the therapeutic experience.
Yes, I understand and agree
No, I do not agree
* If you are not present at the time our session begins, you can expect the following - 1) if you have provided text and/or e-mail consent, I will text/e-mail you (as your preference indicates) to ask whether or not you will be attending session, at five (5) minutes after the scheduled start time for session; 2) if you have not responded by ten (10) minutes after the scheduled start time for session, and you have provided a consent for phone contact, I will call you at the primary number on file. If you have provided consent, and your voicemail is not full, I will leave a brief message; 3) If you have not arrived by fifteen (15) minutes after the scheduled start time for session, we will not be meeting. You will be charged for a no show/late cancellation, the full out of pocket cost for a session.
Yes, I understand and agree
No, I do not agree
* NOTE: If you are using insurance to meet for sessions, and you are later than four (4) minutes for ANY reason for ANY session, the only possible outcomes are: 1) we will not have that session, and you will pay a late cancellation/no show fee; or 2) you will pay out of pocket at the full session rate for the session for whatever amount of time we are able to meet. That fee will not be prorated or reduced due to your own reduced session time. This is due to the strict insurance requirements and documentation which determines when or if you care is covered - in these cases, it is NEVER covered, and the financial responsibility becomes your own.
Yes, I understand and agree
No, I do not agree
* I understand that whatever specific day and time Finley and I agree on is to be the only day and time I am to assume will be available to me consistently.
Yes, I understand and agree
No, I do not agree
* By electronically signing this document, I consent to the above clauses.
By checking this, you are eSigning this form.
* I also understand that if my scheduling needs change, I am encouraged to bring this up with Finley during session. However, in no circumstances can a change of schedule ever be promised, and should never be assumed to be available, until the direct conversation has been had between us, and a commitment to an ongoing time change has been agreed upon by all parties, therapist and client(s). If schedules cannot be made to align, we will discuss and begin termination of care, for which I will do my best to provide competent referrals to other clinicians.
Yes, I understand and agree
No, I do not agree
* I understand that to the best of their ability, Finley will be as flexible as possible with periodic session time changes due to extenuating (stressful and non-typical for you, and which you cannot control) circumstances. However, they can not make any promises that they will be able to provide a session reschedule.
Yes, I understand and agree
No, I do not agree
* I also understand that once I am an established client, in cases of danger or mental health crisis, that Finley will do what is possible within their scope of practice to attend to any new clinical needs that may develop. I also acknowledge that if it is not possible for these new and important aspects of care to be attended to appropriately and ethically within the existing therapeutic relationship, we will have an open discussion around care needs and transition of care.
Yes, I understand and agree
No, I do not agree
* * I acknowledge and understand that if I choose "No, I do not agree" on ANY portion of this form that I will not be establishing a therapeutic relationship with Finley. Additionally, any appointments that were pre-scheduled as placeholders prior to completion of this paperwork will be cancelled. If said appointments are cancelled, and are also scheduled for less than 48 hours in the future, you will be responsible for the full out of pocket session rate for a late cancellation. To the best of their ability, the clinician will offer me referrals for care elsewhere.
Yes, I understand and agree
No, I do not agree