9. Once you start using, at home, the processes and techniques you will learn in sessions, you might “get stuck”. I will be happy to help you get “unstuck” over the phone. With two caveats: (a) To maintain my neutrality, I will only speak to the two of you together. (b) After the first 10 minutes you will be billed in 15 minutes increments.
10. If either of you tell me something outside the couple’s session, it will be shared with your partner in the next couple session.
Payments and Insurance Claims
11. PAYMENT FOR SERVICES IS EXPECTED AT THE BEGINNING OF EACH SESSION. I accept payment by cash or check. I do not take credit cards. If a monthly payment is preferred, it must be made at the beginning of each month.
12. For clients paying out of pocket, who would like to use their insurance benefits, I will be happy to provide a monthly claim (at the END of the month) and any reimbursements will be either applied to their balance or directly sent to them (depending on the insurance benefits.)
In the event that your check is returned by your bank, for whatever reason, you will be expected to reissue the amount of the check, plus a $20.00 return fee. A second returned check will require you to pay for your sessions in cash.
Referrals
13. My practice is built on referrals. If you are satisfied with and are benefiting from our professional relationship, I hope you will refer your colleagues, friends and family to me.
To indicate that both of you have read, understood and agree to abide by the policies stated above, please sign and date this paper.
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Client
Date
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Client
Date
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Therapist
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So, welcome aboard and I am looking forward to meeting with you and participating in this collaborative and healing process.