Welcome to Hollywood Psychology Center. This document contains information about the professional services and office policies which are an integral part of our work together. Please read this document. Please feel free to discuss any questions you may have now or develop later.

Sessions – Session time is usually 45 minutes or 1 hour. Session frequency can be discussed with office or at intake.

Benefits and Risks of Therapy– Participating in therapy can result in a number of benefits to you, including a better understanding of yourself, alleviation of painful feelings, improved interpersonal relationships, better physical and mental health, and hopefully the resolution of the specific concerns that led you to seek therapy. However, it is also true that therapy can be uncomfortable, especially when painful feelings arise or when unpleasant aspects of your history or your present situation come up. For therapy to be effective, you need to be an active participant, both in and outside the therapy sessions. Between sessions notice what comes up for you regarding what we have discussed and what it means to you. Come to each session prepared to talk about your thoughts and especially your feelings on prior or new issues, because it is the client who determines the goals of therapy.There are no guarantees about what therapy will do for you. At times, participating in psychotherapy results in changes that you may not expect or that you did not originally intend.

Fees – HPC does not offer free therapy. However, we accept many insurance plans. This fee may be revised from time to time. HPC accepts cash, check, or credit cards. We will inform you of and changes by HPC. However, we cannot be responsible for changes made by your insurance company that may effect you. The Client assumes any and all risks associated with postdating checks or delaying deposits, and will reimburse HPC the cost of ‘bouncing’ checks.

Cancellations – Once we decide to work together, we reserve a time specifically for you. Please cancel only in the case of emergencies. You will be responsible for the full session if you do not cancel with a 24 hour notice or if possible with as much advance notice as possible. Please note that insurance companies do not reimburse for missed sessions.

Contacting Me & Emergency Procedures – You may leave confidential phone messages at any time. It helps if you leave a few specific times when I can reach you. I will do my best to return your call on the same day or the day after. If I will be unavailable for an extended time, I will provide you with the name of a colleague for you to contact if necessary. In an emergency or immediate physical or medical crisis, contact the police (911) or go to the nearest emergency room or hospital.

Confidentiality – Your privacy is extremely important to me and for our work together. What you disclose to me is generally protected by laws and ethics. I need your permission before I may release any information concerning your treatment, except under the following circumstances: 1) if there is a reasonable suspicion of abuse/neglect of a child, elderly, dependent, or disabled person; 2) if you may be in danger of harming yourself or another person; 3) as required by a third-party to obtain reimbursement; and 4) as otherwise ordered or required by law (for example as a result of a court order).This form does not cover every possible exception. Please refer to the HIPAA Notice of Privacy Practices, which we supplied you.

Records – I keep confidential records and personal information of our sessions. However, if you are using insurance or the employee assistance program for payment, they have a legal right to your information including records.

Additional Charges – Additional charges may be assessed for services other than therapy in session. Additional charges may be discussed with the office staff in advance for such things as psychological assessments, request for specific letters, copies of records, litigation or others not listed here. There might be psychological assessments we decide to do, you may request a letter. I expect to discuss extra fees for such services in advance.

Conclusion of Therapy – Termination is an important aspect of the therapeutic process and should be based on a careful discussion.

I have read this agreement, understand it, and have had my questions answered. I accept, understand, and consent to participate in treatment. I give HPC permission to thank the individual for referring me to HPC.