An adult client is considered responsible for his/her own account. The responsible party for a minor account (under the age of 18) rests with the parent/guardian seeking services.
Do not fill this page if information is same as above
The above information is accurate and Complete to the best of my knowledge
APPOINTMENT REMINDER/CONFIRMATION CALLS
If there is a mental health Emergency, Please call 911 or go to the nearest Emergency room.
Should there be an URGENT need to speak with your Therapist
Call 616-296-2130 during business hours
231-923-2678 if after business hours.
Our staff will work with you to reach your therapist if at all Possible
Please be advised there will be a regular session fee charge based on the time used and are often not billable to your insurance company.
I understand that there are Fees associated to phone calls with my therapist and I will be personally responsible for those charges.
PUNCTUALITY AND ATTENDANCE
When you make an appointment, your mental health Professional will reserve that time for you. it is your responsibility to keep the appointment and apply yourself wholeheartedly to benefit from each session. Frequent cancellation will also obstruct your progress in treatment and may result in the discontinuation of treatment.
If you are late, you still will be charged for the full scheduled appointment. If you miss and appointment or cancel less than 24hours in advance there is a service charge of 50% of the standard fee for the scheduled service which is Not coverd by your Insurance. this is not a penalty, but rather a payment for time reserved for you. It is your responsibility to contact the office of Copassionate Christian Counseling and reschedule your cancelled appointment.
I understand that 24 hour notice must be given for all cancelled appointments to avoid the 50% cancellation fee.
COST OF TREATMENT
Please understand that payment of your bill is considered a part of your treatment.
Our independent professionals are committed to providing the best treatment possible for you. They charge what is usual and customary for our area.
Standard billing fees are:
Initial Session Fee $200.00
Following Sessions $175.00
If you do not have insurance coverage or you have an insurance that we do not bull we do require payment in full at the time of services. NOTE: Some therapists do offer a sliding scale for uninsured clients. Inquire with office staff or your therapist for this option.
When utilizing a qualified insurance carrier, you will be required to pay all copays at the time of services.
When deductibles are required, we will bill you after the unsurance determination and require your payment in full within 30 days.
The balance is your responsibility whether your insurance company pays or not.
Your insurance policy is a contract between you and your insurance company. You should contact your carrier as to what your benefits are along with your copay and/or deductible that may be required.
WHAT TO EXPECT FROM TREATMENT
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CONSENT FOR TREATMENT FORM
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CONSENT FOR TREATMENT OF MINORS.( IF THIS PERTAINS TO YOU)