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This is a contract for services with The Journey Center, LLC. In order to begin therapy, you must agree to the following:

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Consent to Treatment 

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I voluntarily consent to receive therapy services and/or to have my child receive services provided at The Journey Center, LLC. I understand that if I am not seen for 60 days or longer, my case will be considered inactive and will be terminated.  I understand that this consent to service will be valid and remain in effect as long as I attend The Journey Center, LLC. Unless revoked by me in writing, with written notice provided to The Journey Center, LLC. I understand that all communication with The Journey Center, LLC are confidential and that no information about my session will be released without my written authorization and the written authorization of each member in the client’s system.

 

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Client Rights and Responsibilities

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You have a right to confidentiality. The only exceptions are: the reporting of child abuse as required by law, reporting of patient’s potential danger to self or others, reporting of patient’s grave mental disability (i.e., inability to properly care for self, due to severe disability) or when ordered by a court of law to release information. As a client, you have the right to choose a therapist who best suits your needs and goals. If you work with me, you have a right to raise questions about my therapeutic approach and to request a referral if you believe you might make better progress with another therapist. I would not be insulted if you asked for a referral for an alternative therapist. Also, if for some reason treatment is not going well, I might suggest you see another professional in addition to or instead of me. To assure quality of care, it is your responsibility to keep me fully up to date about any changes in your feelings, thoughts, and behaviors and to cooperate with treatment to the best of your ability.

 

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Termination of Service

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I may terminate therapy with you in the following situations: 1) you fail to pay the negotiated fee; 2) you are not cooperating with the appropriate treatment recommendations; 3) there is a discovered conflict of interest. 4.) The practice is moving or closing.

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Multiple Relationships

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The therapist can only be your therapist. It is unethical for a therapist to be a close friend or socialize with a client. Even though you are free to invite the therapist, they will not attend your family gatherings, such as parties or weddings. The therapist will not celebrate holidays or give you gifts, and they may refuse gifts from you.

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Confidentiality

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As a client in counseling, you have certain rights that are important for you to know about. There are also certain limitations to those rights of which you should be aware. As a client of a therapist, you have privileged communications under state law. With the exception of the situations listed below, you have the right to have information you share with me held in strict confidence; that information includes the fact that you are seeing me. The privilege is yours, not mine, and cannot be waived without your consent. I will always act to maximize your privacy even when you waive your right to confidentiality. The following situations are exceptions to your right of confidentiality

 

1. If I believe that you are likely to do harm to yourself or to another person, I am required by law to take steps to protect you and/or the other person.

2.  If I believe that you may be physically or sexually abusing or neglecting a minor child or vulnerable adult, or if you report information to me about the possible abuse or neglect of a child, I am required by law to report this to Children's Protective Services, a state agency.

3.  If you are currently in litigation or become involved in litigation during the treatment process or file a complaint against someone for malpractice, I may be asked to disclose information regarding your therapy as part of that process. Although I will request your consent to release information, I can be legally obligated by subpoena or court order to turn over my records and testify. Nevertheless, please inform me as soon as you know that you are likely to be in such a legal situation; so that I can exercise due caution so as to protect your privacy.

4. Disclosures may also be made if (a) you sign a written authorization permitting disclosure; (b) you file a complaint against me; (c) a contracted third-party agent contacts you by mail or phone to receive payment for a balance due that exceeds 90 days.

 

Cancellation Policy

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Clients who wish to cancel an appointment must do so before 12:00pm the day prior to their scheduled appointment time. Otherwise, the full session fee will be charged.

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Scheduling Follow Up Appointments & Payments

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You will be provided with the recommended course of therapy and sessions at the conclusion of your first appointment.  If your session is not paid in full prior to 24 hours of your appointment time, your appointment will not be confirmed.

 

Professional Fees

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Payment of our professional fees is required in the following installments, and must be paid on request:

 

Fees for Therapy

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$150 per 50-minute couple session and $150 per 50-minute individual session with a Clinical Mental Health Counselor (LCMHC), Licensed Clinical Social Worker (LCSW) and or a Licensed Clinical Addictions Specialist Associate (LCASA).

 

Acknowledgement

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I understand and accept the contract terms as stated above.

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I understand that it is my responsibility to track my scheduled sessions and I will not receive a reminder from the therapist. I understand the above fee policy and agree to pay the above amount for the services being rendered. I have been given the opportunity to read this agreement and all related documents in full and in my own time. I have also been offered the opportunity to have any matters contained therein explained or clarified, prior to entering into this agreement.