Hello. Welcome to MiCasa Behavioral Health Services. I'm glad you're here and look forward to serving you. Please take a few minutes to read through this handout concerning my services, informed consent, and my office policies. Should you have any questions about these polices or any aspect of my practice, do not hesitate to call or email me to discuss them at any time.
Initial Assessment $125 based on a 60min session
60 min session $95
60-75 min $100
PAYMENT FOR SERVICES:
Clients or guardian of client are expected to pay for services at time services are rendered unless previous arrangements have been made. Cash or check only, check can be made payable to "Mi Casa Behavioral Services" before session begins to use the maximum time for your session. Client, guardian of client, is responsible for payment of all services provided even if billing an insurance company for reimbursement.
In order to set realistic treatment goals at the start, we must first evaluate what resources you have to pay for therapy. Should you have mental health insurance coverage, it may provide some coverage for my services on an out-of-network basis. I can provide you with any assistance you need in helping you get the most of your benefits. However, you (not the insurance company) are responsible for full payment of my fees at the time of service. Please let me know at the initial session and I can provide you with an invoice detailing all the information the insurance company will need to reimburse you. After the initial visit, invoices will be provided at the end of each month.
Should you have any trouble meeting your payment obligations, please talk to me right away so that we can come up with a reasonable payment plan. Overdue accounts (unpaid for 30days) may be transferred to a collection agency as a final means for payment. Overdue and collection charges may apply to overdue accounts.
Please provide at least a 24 hour notice to cancel and/or reschedule your appointment. The full fee will be charged for missed sessions without this notification.
MESSAGES AND VOICE MAIL:
You are welcome to leave a voice message 24 hrs a day, 7 days a week at 210-844-1296. Your message will be returned by the next business day or sooner. If it is an emergency, contact 911 immediately. You may also email or text me a message. Remember, such messages are part of our communication and are legally required to be part of your record. Please limit texts and email to information about appointment times only.
I will not “friend” a current or former client on Facebook, LinkedIn, or any other social media sites nor will I follow you in return so as to protect our professional relationship.
I am an independent practitioner. I have no professional affiliation with any other therapists who practice psychotherapy in the area.
Your privacy in our sessions is extremely important to me. Information discussed in our private sessions will not be disclosed to any individual or organization without your written permission. I am required not to discuss or disclose information without your written consent by confidentiality regulations by federal laws as well as by professional standards and ethics.
There are limits to confidentiality that supersedes my control of protection of your privacy:
1. I am required to report any situation of suspected child abuse or neglect, or abuse or neglect of an elderly or disabled person to law enforcement.
2. I am required to break confidentiality and contact law enforcement if I believe a client may harm him or herself or another person.
3. If a client discloses the identity of a mental health professional with whom they engaged in a sexual contact during the treatment process, state law requires that I report that mental health professional to authorities.
Please review and sign the Consent Form