Contract

Appointments: Our appointments are your time to use as you wish. Those that are not utilized, or are canceled without sufficient advanced notice, will be charged at the full fee. “Sufficient notice” is at least 24 hours, and more. Appointments that exceed 50 minutes will be charged according to the hourly rate. Pease not that phone calls or any correspondence to the client or any third party individuals that exceeds 10 minutes will be charged at the hourly rate. Please also note that third party payers will not reimburse you for the charges of missed appointments. Messages can be left at (801) 885-4689

Fees and Billing: Our services are based on a fee-for –service contract. Please be prepared to pay for services at the time of appointment. In special circumstances, payments can be delayed, but this must be arranged with your therapist, and interest will accrue at a rate of 1.5% per month. In the event that full payment for charges incurred is not made, you will pay all costs osf collection, court cost, and attorneys’ fees.

Insurance Coverage: Your work with your therapist may be covered by your health insurance. Please remember expenses. Generally we ask for full payment at the time of each visit. We will provide to you the information and receipts that are necessary for most insurance companies. If this is not sufficient, we will help you in filling out an initial report or company claim. Laws regarding information given to insurance companies are included in HIPPA regulations.

Confidentiality: Professional ethics, as well as the laws of the State of Utah, require that we honor your right to privacy and the confidentiality of our work together. We will not provide information about you to others without your informed consent and written permission except as required by law. We must report clear and present danger to human life and any form of child or elder abuse, as well as infectious diseases. Minors and Parents: Clients under the age of 14 who are not yet emancipated and their parents should not the at the law may allow parents to examine their child’s records unless deemed harmful to the child. Our policy is for clients 14-18 and parents to contract about general information that can be shared with parents. Laws regarding court proceedings are included in HIPPA regulations.

Emergency Coverage: We do not provide 24 hour emergency coverage at this office. In case of emergency, you may leave a message with my 24 hour answering service, and we will return you call as soon as possible. If you are unable to make contact with your therapist personally, we recommend that you contact your family physician, local hospital emergency room, or the crisis unit at your local mental health center.

Fees: For a 50 minute appointment $90. Please make your Payments via www.ldshopeandrecovery.com.

Your signature below indicates that you have received the Notice of Privacy Practices Indicating our compliance with HIPPA rules. You may ask questions regarding these practices at any time.

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