Thank you for taking this step. Whatever you've heard from friends, family, or your own inner critic, coming to therapy is a good decision. This is a place where every part of you is welcome — including the parts that feel hard to talk about. We're honored you've chosen us to be part of that process.

If this is your first time in therapy: welcome. Starting can feel scary, sitting down with someone you don't know and talking about things that make you sad, angry, embarrassed, or even overjoyed. That's normal. 

Therapy works best when certain things are in place: a sense of safety, room to grow, space to be honest. But maintaining that isn't on you. It's on us. We're here to create a space that's judgment-free, that can be challenging but still feels supportive, and that helps you look both inward and forward.

If you've been to therapy before: welcome back. Maybe your last experience wasn't great and you're giving it another shot. Maybe it was helpful and you're back because you know what's possible. Either way, you're welcome here. We hope this time builds on what's worked before, or opens up growth that an earlier experience got in the way of. Coming back often means revisiting old work and figuring out, together, what your path looks like now.

Whether you're starting fresh or picking this up again, we hope you'll feel free to be your real, whole self in our sessions. Cry without apologizing. Say what's true without hedging. If that doesn't feel possible yet, that's okay, it's part of what we're here to work on together. We want everyone who walks through our door to leave with a clearer sense of who they are and a little more appreciation for themselves.

This packet covers important details about how we work and the policies of my practice. Please read through it and bring any questions to your first session. Once you've reviewed and signed it, this packet becomes the agreement between us.

 

Thank you for your cooperation and patience in filing out this packet!

  

 

Office hours are as follows:

• Monday: 8:00 AM – 8:00 PM
• Tuesday: 8:00 AM – 8:00 PM
• Wednesday: 8:00 AM – 8:00 PM
• Thursday: 8:00 AM – 8:00 PM
• Friday: 8:00 AM – 5:00 PM
• Saturday: Closed
• Sunday: By appointment only

Non-emergency emails, calls, and text messages received after 7:00 PM Monday through Thursday, or after 3:00 PM on Friday, will typically receive a response the following business day.

We keep scheduling flexible, since we know a fixed weekly time doesn't work for everyone. That said, if a regular weekly slot does fit your life, we'll do our best to hold that same time for you each week.

We don't schedule sessions on Saturdays, though Sunday mornings may be available on an as-needed basis. We're also closed for major holidays, and your therapist will give you a heads-up if one falls on your regular day.

LATENESS, MISSED APPOINTMENTS & CANCELLATION POLICY:

As therapists, our time and clinical expertise are the services we provide. When we schedule your appointment, that time is reserved exclusively for you — we do not double-book or offer it to another client. We ask that you treat your appointment time with the same care, and we commit to extending you the same respect in return.

This policy applies equally to in-office and telehealth (video/phone) sessions. All appointment times refer to the time zone of your treating provider's office, Eastern Time, unless otherwise noted in your intake paperwork.

LATENESS:

If you know you will be late, please contact us in advance by phone or email so we can plan accordingly.

Session end time does not change. Regardless of when you arrive or log on, your session will end at its regularly scheduled time, and you will be billed the full professional rate (see fee schedule below for the specific rate).

• 10 minutes late: If we haven't heard from you 10 minutes into your session, we will reach out by text and/or email to check in.
• 20 minutes late: If we haven't heard from you by 20 minutes into your session, you will be considered a no-show. The session is forfeited and your card on file will be charged the full professional rate.

MISSED APPOINTMENTS & CANCELLATIONS:

We require a minimum of 24 hours' notice to cancel or reschedule any appointment. Appointments cancelled with less than 24 hours' notice are billed at the full professional rate (not your copay) to the card on file.

This fee may be waived if the appointment is rescheduled within the same calendar week, subject to your therapist's availability.

How the 24-hour window works:Notice must be given at least 24 hours before your scheduled start time.

• Example: A Tuesday 3:00 pm appointment requires notice by Monday at 3:00 pm.
• Example: A Monday appointment requires notice by the prior Friday, at the same appointment time.           

Cancellations must be made by phone or email directly to your provider. Notice is considered "given" at the time your message is sent (call placed, voicemail left, or email/text sent) — not when it is read or returned — even if sent outside of business hours, on a weekend, or on a day the office is closed.

Missed (no-show) appointments and late cancellations are never billed to insurance. These charges are your direct financial responsibility, billed to the card on file.

Emergencies: We understand that genuine emergencies such as a sudden medical event, accident, hospitalization, or death in the family can make 24-hour notice impossible. If this occurs, please notify us as soon as you reasonably can. Your therapist will use clinical judgment to determine whether the late-cancellation fee is waived in these circumstances; documentation may be requested.

FREQUENT CANCELLATIONS OR MISSED APPOINTMENTS: 

Therapy is most effective with consistent attendance. Because of this: 3 or more cancellations/no-shows within a 6-month period, or 3 consecutive missed/cancelled sessions, may result in termination of treatment.

If termination is necessary, your therapist will provide reasonable advance notice, discuss the decision with you directly, and, where appropriate, offer referrals to other providers or resources to support continuity of care. Termination is not automatic or immediate solely on the basis of meeting this threshold; it reflects a clinical judgment that the pattern of attendance is no longer supporting effective treatment.

If you have a standing recurring appointment, that time slot will remain on the calendar even after a missed or cancelled session unless and until treatment is terminated.

APPOINTMENT REMINDERS:

As a courtesy, Wavelength Psychotherapy may send text and/or email reminders ahead of your appointment, provided you've consented and given us a valid email address and cell number.

• Reminders are a courtesy only, not a guarantee.
• You are solely responsible for tracking and attending your scheduled appointments, whether or not a reminder is sent or received.
• It is your responsibility to notify our administrative assistant and/or your therapist if your phone number or email address changes. Please send updates to hello@wavelengthpsychotherapy.com.

WHEN YOUR THERAPIST CANCELS:

If your therapist needs to cancel, reschedule, or is late to a session including due to illness, emergency, or office closure (e.g., inclement weather or holidays) you will be notified as soon as possible, will not be charged for that session, and will be offered the next available rescheduled appointment as a priority.

Daily, we are often not immediately available by telephone. Our telephones are usually answered by voicemail which we monitor frequently. We will make every effort to return your call on the same day with the exception of weekends and holidays. If you cannot reach your therapist, and you feel that you cannot wait for us to return your call, please call your primary care physician, 911, or go to the nearest emergency room and ask for the mental health professional on call.

• New Jersey: 211 is a free referral and information helpline that connects people to a wide range of health and human services including mental health, 24 hours a day, 7 days a week. Dial 211 from any phone.
• New York: NYC Well is 24/7, free, confidential, and available for all New Yorkers. If you are in crisis or would like emotional support, please call 1-888-NYC-WELL, text WELL to 65173.

Because Wavelength Psychotherapy, LLC therapists are not often immediately available by telephone, email and text messaging, may be a primary contact between you and your therapist.

I {namefirstlast} consent to receive text messages and/or e-mail from my Wavelength Psychotherapy, LLC assigned therapist, on my cell phone or other devices. I understand that text messages sent by my therapist may include appointment reminders, my meeting Zoom link and/or changes in previously scheduled appointments. My therapist may also reach out with guidance or to check-in about scheduling sessions moving forward.

I {namefirstlast} understand that Wavelength Psychotherapy, LLC does not charge its' clients for this service, but that standard text message rates may apply as provided my wireless plan.

I {namefirstlast} understand that I may revoke my request for further communications via text or e-mail at any time by notifying my therapist in writing. However, if I continue to communicate with my therapist via text or e-mail, my therapist and/or Wavelength Psychotherapy, LLC support staff can assume that my consent remains valid.

Lastly, because e-mail sent over the internet or text messages sent over the control channel without encryption are not secure, I {namefirstlast} understand the risks associated with e-mail and text messaging, including; without limitation, that e-mails and text messages could be intercepted by unknown third parties, e-mail content can be changed without the knowledge of the sender or receiver, backup copies of e-mail may still exist even after the sender and receiver have deleted the messages, and e-mail can contain harmful viruses and other programs.

Wavelength Psychotherapy, LLC recommends that I delete all text messages or e-mail as soon as possible after receiving them in order to help prevent any unauthorized exposure.

 

Due to the importance of your confidentiality and the importance of minimizing dual relationships, Wavelength Psychotherapy, LLC therapists DO NOT accept friend and/or contact requests from current or former clients on any social networking site (i.e. Facebook, Instagram, LinkedIn, etc).

We believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship.

If you have any questions regarding this matter, please feel free to raise them during your session with your therapist, and they will be available to provide further information and address your concerns.

PROFESSIONAL FEES:

Below are Wavelength Psychotherapy's professional rates for service(s).

PLEASE NOTE: Fees are subject to quarterly review. 

Initial Consultation Calls (15-20 mins)	Free
Intake Session (90 Mins)	$200.00
Individual Session (45 Mins)	$160.00
Individual Session (55 Mins)	$180.00
Couple/Family Sessions	$185.00
Out-of-Session Work: This includes phone calls lasting 10 minutes or more, as well as oral or written communications with the client, family members, other practitioners, academic institutions, attorneys, hospitals, and insurance companies.	$50.00 per hour (not billable to your insurance)
Report Writing and/or Treatment Letters	$150.00 per hour (not billable to your insurance)
Records Requests	$150.00 per hour (not billable to your insurance)
Doctoral Level Therapists	$200 per hour

 

PAYMENT:

Wavelength Psychotherapy requires that all anticipated payment responsibilities and visit fees be collected at the time of service. This includes copayments, coinsurance, deductible amounts, and self-pay session fees. All fees for services rendered must be paid at the time of service, unless alternative payment arrangements have been pre-approved by Wavelength's billing department (hello@wavelengthpsychotherapy.com).

For both insurance and self-pay clients, a credit card must be kept on file to facilitate payment of professional service fees. This includes, but is not limited to, charges for copayments, coinsurance, late cancellations, missed appointments, and overdue balances.

Accepted payment methods: most major credit cards; cash (in-person clients only).

HEALTH INSURANCE AND BILLING:

Your health insurance is a contractual agreement between you and your insurance company, intended to assist in covering medical care costs. If you opt to use your health insurance for your care expenses, our billing department will promptly submit claims directly to your insurance provider after each service. We submit claims on a biweekly basis. 

Your health insurance is a contractual agreement between you and your insurance company, intended to assist in covering medical care costs. If you opt to use your health insurance for your care expenses, our billing department will promptly submit claims directly to your insurance provider after each service. We submit claims on a biweekly to triweekly basis.

Once we submit your claim to your health plan, it typically takes 45–120 days for the plan to review the details and determine the final cost for the session. Additionally, health plans may reprocess claims weeks or even months later if they identify an internal processing error. Your payment responsibility, based on your plan, will be charged to the card on file on a biweekly to monthly basis.

It is important to note that insurance companies do not guarantee payment for services, and you, the client, assume ultimate responsibility for any expenses incurred if your insurance coverage falls short of expectations. You are responsible for payments of services not covered by your insurance carrier and must negotiate with your insurance company directly for any unpaid services. Unpaid services may encompass, but are not limited to:

•  If your insurance carrier denies or rejects payment(s) for any rendered services, resulting in non-coverage, you will receive an invoice and be charged the full session rate. 
• In the event of a lapse in your insurance policy, and we are not notified before your next appointment, you will be invoiced and charged the full session rate.
• Your health plan determines that the services received are not medically necessary and/or covered by the insurance plan, you will be invoiced and charged the full session rate.

We strongly advise you to familiarize yourself with your outpatient mental health benefits before your first appointment. 

*A NOTE ON SECONDARY INSURANCE: Please be advised that insurance companies do not coordinate benefits with secondary insurance. We do not submit secondary claims; however, if you wish to forward your claims to your secondary insurance for reimbursement, we will provide you with an invoice for each session, which you can forward to your secondary insurance and/or supplemental insurance.

*A NOTE ON MEDICAID, MEDICARE and/or COMMUNITY-BASED INSURANCE PLANS: We do not accept Medicaid, Medicare, or any Community-Based insurance plans. It is the client’s responsibility to review their individual insurance card for this information prior to proceeding with this packet. If you have any questions about your insurance coverage, we recommend contacting your insurance provider directly to confirm your plan details.

BALANCES:

Wavelength Psychotherapy, LLC does not permit clients to maintain an outstanding balance on their account.

Any balance that remains unpaid for more than thirty (30) days after services are rendered will be automatically charged to the credit card on file. This includes all fees, copayments, deductibles, coinsurance amounts, and other charges associated with services provided.

If you are experiencing financial hardship and are unable to make payment, we encourage you to discuss this with our office as soon as possible. We may determine that it is appropriate to pause services or develop an alternative payment arrangement to help prevent the accumulation of additional charges. If ongoing treatment with our practice is not feasible, we will make reasonable efforts to assist you in identifying alternative sources of care.

Accounts that remain unpaid for ninety (90) days or longer and for which no good-faith effort to resolve the balance has been made may be subject to collections activity or other legal remedies permitted by law.

SELF PAY: 

If you are paying out-of-pocket, all fees are charged directly to you at the time of service using the payment method on file, not through your insurance company. You are responsible for payment.

At the end of each month, a superbill detailing the services provided will be issued through our Electronic Health Record system. You may use this document to submit directly to your insurance carrier for reimbursement. Please note, we are not responsible for assisting with the reimbursement process beyond providing the superbill.

OUT OF NETWORK:

If you are eligible for out-of-network services, it means that Wavelength Psychotherapy is not affiliated or credentialed with your insurance company. However, if your plan includes out-of-network benefits, your insurance company will typically reimburse you directly once you've met your deductible. 

*Clients receiving out-of-network care at Wavelength are required to pay the entire cost of services upfront. 

Once you confirm your plan provides out-of-network coverage our team, we will send a superbill each month for you to submit directly to your insurance carrier for reimbursement. The insurance company will assess the superbill, determine the eligible amount based on their out-of-network coverage policy, and then issue reimbursement directly to you (the client). 

Remember to confirm the estimated reimbursement amount with your insurance company as they have the most up-to-date information about your benefits. Additionally, if you are going to have telehealth sessions, it is important to confirm you are eligible for telehealth services.

Questions to ask your insurance representative:

• “Does my plan include out-of-network benefits for mental health care? Specifically, for outpatient psychotherapy?” “And, telehealth visits?”
• “Do I have a deductible for out-of-network mental health services? If yes, what is the remaining amount I will have to pay before my health plan starts to reimburse me for fees that I pay out-of-pocket?”
• “What is the maximum amount my plan will reimburse for mental health service code 90837 with a Psychotherapist?” If the rep does not provide a clear answer, ask: “What is the maximum allowed amount for mental health service code 90837 with a psychotherapist, and what percentage of the maximum allowed amount will my plan pay?” (This percentage of the maximum allowed amount is the amount you would receive as reimbursement.)

 

CREDIT CARD AUTHORIZATION:

Wavelength Psychotherapy, LLC requires all clients to maintain a valid credit card on file. By providing your credit card information, you authorize Wavelength Psychotherapy, LLC to charge the card for professional service fees, including but not limited to late cancellation fees, missed appointment fees, copayments, deductibles, coinsurance amounts, and any outstanding balances for services rendered.

It is the client's responsibility to ensure that all credit card information remains current and accurate. Failure to maintain valid payment information may result in delays or interruptions in services.

All financial information is securely stored through a HIPAA-compliant, encrypted payment processing system provided by SimplePractice, LLC.

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Wavelength Psychotherapy, LLC reserves the right to amend the above Financial Policies at any time, and these modifications will apply to all our clients. In the event of any changes to this policy, Wavelength will provide you with a revised policy for your review and signature.

I {namefirstlast} hereby acknowledge that I have read, understand, and agree to all financial policies outlined above and/or pertaining to the use of health insurance, billing, professional rates, payments, balances, lateness, missed appointments and cancellations. By signing this agreement, I legally commit to complying with these policies.

I {namefirstlast} understand that I am eligible to receive a range of services from my therapist. The type and extent of services that I receive will be determined following an initial assessment and thorough discussion with me. The goal of the assessment process is to determine the best course of treatment for me. Typically, treatment is provided over the course of several weeks.

I{namefirstlast} understand that I have the right to ask questions throughout the course of treatment and may request an outside consultation. I also understand that my therapist may provide me with additional information about specific treatment issues and treatment methods on an as-needed basis during the course of treatment and that I have the right to consent to or refuse such treatment. 

I {namefirstlast}understand that I can expect regular review of treatment to determine whether treatment goals are being met. I agree to be actively involved in the treatment and in the review process. No promises have been made as to the results of this treatment or of any procedures utilized within it. I further understand that I may stop treatment at any time, but agree to discuss this decision first with my therapist.

By providing my signature below, I {namefirstlast} understand the practice of behavioral health treatment is not an exact science and acknowledge that no one has made guarantees or promises as to the results that I may receive. I voluntarily request and consent to behavioral health assessment, care, treatment, or services and authorize my Wavelength Psychotherapy, LLC therapist to provide such care, treatment or services as are considered necessary and advisable.

By signing this Informed Consent to Treatment Form, I {namefirstlast} acknowledge that I have both read and understood the terms and information contained herein. Ample opportunity has been offered to me to ask questions and seek clarification of anything unclear to me.

The law protects the privacy of all communications between a therapist and a client. In most situations, Wavelength Psychotherapy, LLC therapists can only release information about your services to others if you sign a written Authorization Form that meets certain legal requirements imposed by HIPAA. HIPAA stands for theHealth Insurance Portability and Accountability Act.

Your Wavelength Psychotherapy, LLC assigned therapist will take appropriate precautions to keep your health information confidential and to not disclose it without your consent.

It is important that you read the Notice of Privacy Practices which is located on our website www.wavelengthpsychotherapy.com under Forms for more detailed explanations. You may request a paper copy.

While this written summary of exceptions to confidentiality should prove helpful in informing you about potential problems, it is important that you discuss any questions or concerns that you may have with your therapist.

Exceptions when your information would not be protected:

1) When there is risk of imminent danger to myself or to another person, my therapist is ethically bound to take necessary steps to prevent such danger.

2) When there is suspicion that a child or elder is being sexually or physically abused, or is at risk of such abuse, my therapist is legally required to take steps to protect the child, and to inform the proper authorities.

3) When a valid court order is issued for medical records, my therapist is bound by law to comply with such requests. 

CONSULTATION:

Therapists at the Wavelength Psychotherapy, LLC consult regularly with other professionals regarding their clients; however, each client's identity remains completely anonymous and confidentiality is fully maintained.

AGREEMENT: 

I {namefirstlast} am aware that I must authorize my therapist, in writing, to release information about my treatment but that confidentiality can be broken under certain circumstances of danger to myself or others.

I {namefirstlast} understand that once information is released to insurance companies or any other third party, that my therapist cannot guarantee that it will remain confidential. 

TELEHEALTH INFORMED CONSENT:

This form is intended to provide you with information regarding Telehealth and/or videoconferencing psychotherapy services. When in-person sessions are not possible or clinically appropriate due to health, scheduling, travel, weather, or other circumstances, Telehealth may be utilized as an alternative method of receiving services.

TELEHEALTH SERVICES:

Wavelength Psychotherapy, LLC operates under a hybrid model of care and offers both in-person and Telehealth psychotherapy services. Our clinicians are experienced in providing therapy through secure videoconferencing platforms. While virtual therapy may feel unfamiliar initially, many clients find it becomes more comfortable and effective over time.

Your therapist will regularly assess whether Telehealth continues to be an appropriate and beneficial treatment modality for you. If concerns arise regarding the effectiveness, safety, or appropriateness of Telehealth services, alternative arrangements may be discussed.

TECHNOLOGY REQUIREMENTS:

Telehealth sessions are conducted through HIPAA-compliant videoconferencing platforms, including Zoom for Healthcare and/or the SimplePractice Telehealth platform. These services provide secure, real-time audio and video communication.

To participate in Telehealth sessions, you will need:

• A computer, tablet, or smartphone equipped with a camera and microphone
• A private location where confidentiality can be reasonably maintained.         
• You will receive an appointment reminder and secure Telehealth link approximately 24 hours before your scheduled session. At the time of your appointment, simply click the link provided. You will enter a virtual waiting room, and your therapist will admit you to the session when available.

RISKS AND LIMITATIONS OF TELEHEALTH:

Although Telehealth provides increased accessibility and convenience, there are inherent risks and limitations associated with the use of technology, including but not limited to:

• Technical difficulties, interruptions, or delays due to internet connectivity issues, software malfunctions, or equipment failure
• Reduced ability to observe certain nonverbal communication cues compared to in-person treatment
• Potential risks to confidentiality despite reasonable security measures
• Circumstances in which Telehealth may not be clinically appropriate for certain mental health concerns or emergencies

If a technological disruption occurs during a session, you should attempt to reconnect using the original session link. If reconnection is unsuccessful, contact your therapist directly. Depending on the circumstances, the session may continue by telephone, be rescheduled, or otherwise addressed at your therapist's clinical discretion.

CONFIDENTIALITY AND SECURITY:

While no internet-based communication system can guarantee absolute security, Wavelength Psychotherapy takes reasonable measures to protect the privacy and confidentiality of your information.

These measures include:

• HIPAA-Compliant Platforms: Telehealth services are provided through HIPAA-compliant platforms utilizing encryption and other security safeguards designed to protect confidential information during transmission.
• Private Environment Requirements: Both client and therapist agree to participate in Telehealth sessions from a location that provides a reasonable degree of privacy. Clients are encouraged to use headphones when possible and to ensure that unauthorized individuals cannot overhear session content.
• Potential Interruptions: Despite reasonable efforts to maintain privacy, interruptions may occur during Telehealth sessions. Household members, visitors, pets, phone calls, alarms, or other unexpected events may interfere with the session. Both client and therapist acknowledge and accept that such interruptions may occur despite efforts to prevent them.

RECORDING POLICY: 

The audio or video recording of therapy sessions, whether conducted in person or via Telehealth, is strictly prohibited without prior written consent.

Requests to record a session may be considered on a case-by-case basis. Any approved recording may occur only after all parties involved, including the therapist, have provided written consent and signed a recording agreement specific to the session(s) being recorded.

Unauthorized recording of any therapy session may result in the termination of services and any other actions permitted by applicable law.

ARTIFICIAL INTELLIGENCE (AI) POLICY:

At Wavelength Psychotherapy, LLC, we believe that psychotherapy is fundamentally a human relationship built on trust, confidentiality, clinical expertise, and genuine connection. For this reason, we do not use Artificial Intelligence (AI) technologies in the provision of clinical care.

Specifically, Wavelength Psychotherapy, LLC and its clinicians do not use AI, machine learning, generative AI, large language models, or similar technologies to:

• Record, transcribe, summarize, or analyze therapy sessions;
• Generate, draft, edit, or complete progress notes, treatment plans, assessments, diagnostic impressions, or other clinical documentation;
• Make clinical decisions, recommendations, diagnoses, or treatment interventions;
• Draft therapeutic communications, clinical reports, letters, or correspondence containing client information;
• Review, evaluate, interpret, or otherwise process protected health information (PHI) for clinical purposes; or
• Communicate directly with clients regarding their treatment or care.

All clinical documentation is completed by the treating clinician. Clinical decisions, treatment planning, assessments, and therapeutic interventions are based solely on the clinician's professional judgment, training, experience, and direct interactions with the client.

Wavelength Psychotherapy, LLC has disabled or opted out of AI-powered features that may be integrated into electronic health record systems, telehealth platforms, communication systems, or other practice-management software whenever such features involve the use, processing, recording, transcription, analysis, or generation of client information.

We are committed to protecting the privacy and confidentiality of our clients and maintaining the integrity of the therapeutic relationship. No client information will be intentionally entered into public or third-party AI systems, including but not limited to ChatGPT, Claude, Gemini, Copilot, Grok, or similar platforms.

Should our use of technology practices change in the future, clients will be provided with written notice and any required consent before AI is used in connection with their protected health information or treatment.

AGREEMENT:

I {namefirstlast}have read the above information on video conferencing psychotherapy (Telehealth), the limitations, the confidentiality caveats and the recording policy. With this understanding, I wish to participate in Telehealth and/or video conferencing psychotherapy sessions when health or other concerns prohibit our ability to meet in person.

 

TERMINATION OF THERAPY: 

Either party retains the right to terminate the therapeutic relationship. You may discontinue treatment at any time and at your sole discretion. Your Wavelength Psychotherapy therapist likewise reserves the right to terminate therapy services at their professional discretion.

Reasons for termination by the therapist may include, but are not limited to: untimely payment of fees, failure to comply with treatment recommendations, conflicts of interest, failure to meaningfully participate in the therapeutic process, presenting needs that fall outside the scope of the therapist's competence or practice, or a lack of adequate clinical progress, including the attendance patterns described above.

Upon either party's decision to terminate therapy, Wavelength Psychotherapy generally recommends that the client participate in no fewer than one termination session, and additional sessions where clinically appropriate. The purpose of such sessions is to facilitate a constructive and supportive conclusion to treatment, and to afford both parties the opportunity to reflect upon the work undertaken.

Where a transition to another provider is needed, Wavelength Psychotherapy will provide professional referrals upon request.

BY SIGNING THIS FORM I {namefirstlast} ACKNOWLEDGE THAT:

• I have read in its' entirety Wavelength Psychotherapy's, LLC, Welcome Packet.
• I have been offered a copy of my completed and signed Welcome Packet.
• Understand my rights under HIPAA (Health Insurance Portability and Accountability Act of 1996).
• By signing this agreement, {namefirstlast}, agrees to waive, release and discharge Wavelength Psychotherapy, LLC, and my assigned Wavelength therapist from any and all liability, including, without limitation, any injuries that may occur during the provision of services under this agreement.
• I, {namefirstlast}, have read, understand and agree to the information provided above and to the terms of this entire agreement including but not limited too, costs of services, payment methods, scheduling, and cancellations policies. 

WAVELENGTH PSYCHOTHERAPY, LLC

HELLO@WAVELENGTHPSYCHOTHERAPY.COM

REVISED JUNE 2026