Welcome to Treehouse Wisdom and Wellness Center. Please provide us with the following information so that we may get you scheduled with one of our clinicians. Missing or incorrect information will delay you being able to make an appointment. Thank you!
If therapy will include your spouse, partner, and/or child/children, please include their information below.
If you will be using insurance, we will need the following information.
Frequency of Sessions?
Weekly or bi-weekly 60-minute sessions are most common. The frequency of sessions is based largely on your needs and situation.
How Long is Therapy?
The amount of sessions needed varies depending on the nature of each person’s concerns, the complexity of the issues involved, the strength of our working relationship, and each person’s commitment to work on the presenting issues. There is a direct relationship between effort applied between sessions and progress over time. Anywhere between 1 and 20 sessions are typical, though more sessions may be needed in some situations.
All information you share with your therapist is private can confidential.Your information will not be released to anyone without your written permission (with some exceptions as explained below):• When information is to be released with your consent you will be consulted regarding what information is to be released.• Your information will be kept on file and in a secure and private location.• You may review the contents of your own counseling file upon request.
Exceptions to Privacy:
Your therapist offers confidential therapy in so far as allowed by the United States Government and the laws of the State of New York. This means that the therapists and supervisors at Treehouse Wisdom and Wellness Inc. have a responsibility to protect information received from you during treatment. In order for any information about you to be shared, usually you must firstsign a HIPAA Release of Information form that allows us to communicate only with the person identified on the release and only regarding specific information identified by you.
From time to time, we discuss our clinical work with colleagues to make sure that we are providing our clients with the best care possible. During these consultations, we do not share our clients’ personally identifiable information. And even though our colleagues do not have any of our clients’ personally identifiable information, they are still ethically bound to keep the information addressed in our consultation discussions confidential.
A client’s confidential information can be released without their consent under the following conditions:
• When the purpose is to protect individuals (including a client) who are at foreseeable and imminent risk of bodily harm or death as a result of a client’s actions.• Under the law, we are mandated reporters, which requires reporting of child and elder abuse/neglect to authorities.• Under subpoena from a court of law.• There are exceptions to confidentiality that apply to personal information disclosed by minors. Your therapist will discuss these with you in session, as applicable.• If you disclose in confidence that you have done something illegal, your therapist is not obligated to report this to the authorities, unless the circumstances involve child abuse, abuse against a dependent adult, or a direct threat to another person (as outlined above).
Email is a quick and convenient method of communication. Many of our clients use it to correspond with us. Please be aware, however, that while every effort is made to safeguard your privacy, we cannot guarantee the confidentiality of email messages. If this is a concern for you, please do not use email to correspond with us.• We will only use email to communicate with you: a) in response to an email you send us or, b) as you authorize it or otherwise request it.
Collaboration with Profession Referral Source:
If you have been referred by another professional (i.e. mental health provider, lawyer, physician, psychiatrist, clergy, etc.), it is customary for your therapist to contact your referral source to acknowledge the referral at the beginning of treatment.
Consent to Release Information:
If you are submitting any health claims to your health insurance provider for the counseling services you receive here, your provider may contact us to obtain information necessary to verify your claim.• The type of information they would typically request includes: 1) date of service, 2) the nature of services provided, and 3) the names of individuals who received the service.• Our experience has shown that verification checks are not common and that most health insurance providers will typically not request detailed diagnosis and treatment plan information, unless the insurance company was the referral source who previously contacted us on your behalf, and contracted with us to provide services to you.
Letters Written on Clients Behalf
All letters written on the behalf of clients, i.e., for the purpose of court, will be subject to an hourly regular rate. Please discuss this with your clinician prior to any request.
I have read this letter in full, and I have been informed of the procedures and conditions as outlined in this letter. I have had an opportunity to discuss these procedures and conditions with my therapist and I am satisfied that my questions have been answered to the extent possible. I accept the help offered with full knowledge and understanding of the relevant procedures and conditions. By selecting YES at the bottom of this form, this is your consent for treatment.
Fee-for-service is a great option when you prefer to set your own treatment schedule. This plan offers greater flexibility and reduces limitations to amount of time you can schedule therapy, what type of therapy you want, and with whom your work with.
Insurance; In & Out-of-Network
• If you cannot attend an appointment, please notify our office 24 hours in advance.
• Please cancel by phone since email delivery is not always instantaneous or reliable.
• The purpose of the 24-hour cancellation policy is to allow enough time for us to fill the vacant appointment slot, thereby meeting the needs of other clients who are waiting for an appointment. The therapist is essentially committing a one-hour (or longer) block of his or her time to a client’s care, and only a limited number of such appointment slots can be booked in a day.
• Cancellation without 24 hours notice provides insufficient notice with which to re-book an appointment and thus represents both lost opportunity for someone else to benefit from that time slot, as well as lost revenue. There is, therefore, a fee charged for a late cancellation or missed appointment of $50 for a 60-minute missed appointment (pro-rated in the event of a longer appointment slot).
• We appreciate that unforeseen events sometimes happen, but please be as respectful of our time as you can. Exceptions to this policy are rare.
• Please be aware that third-party reimbursement providers (i.e. health insurance companies) typically do not reimburse for late cancellation charges or no show charges.
• If you provide your email address or your mobile number to our scheduling system you can request an email or text message reminder notification about your appointment. Please note that these reminder notifications are a courtesy only. Our clients are fully responsible for any appointments they have booked even if they receive no reminder notification.