Carol Colhoun, LCSW, LCDC
Statement of Understanding, Consents, and Office Policies
(Please read carefully)
Welcome to my therapy practice! I hope that your experience here is healing, insightful and rewarding. Following are consents, office policies and statements of understanding.
Informed Consent for Treatment: I, the undersigned, and/or my undersigned guardian, voluntarily consent (or give my consent, that the person/persons for whom I am responsible) to participate in outpatient individual, couples, group and/or family psychotherapy with Carol Colhoun, LCSW, LCDC.
General Policy Statement: In order to maintain a safe counseling environment, clients participating in counseling must be abstinent from mood altering drugs and chemicals, including alcohol and any illegal substances.
Fees and Financial Policies: Payment is due at the time that services are rendered. All charges are the client’s responsibility from the date services are rendered. Initial Evaluation sessions are approximately 60 minutes in length. Session charges are as follows: 50 minute session: $150.00; 60 minute session: $180.00; 75 minute session: $225.00; 90 minute session: $270.00. EMDR sessions typically require 90 minutes. Telephone therapy sessions will be billed on a pro-rated basis (no charge for 10 minutes or less). Document preparation fee is $45.00.Substance abuse evaluations: $200.00). From time to time I have found it necessary to raise my fees in accordance with inflation, cost of living/cost of doing business increases. I will do my best to let my clients know well in advance when this may occur.
Confidentiality: All information shared with me is considered strictly confidential, and will be respected and treated as such according to professional ethical standards and within the legal boundaries governing our relationship agreement. An exception should be noted, however, when I feel, based on information shared with me, that your life or someone else’s life might be in danger, or if there is suspicion of child abuse, elder abuse, or sexual abuse. In that case, I would contact the appropriate persons or authorities.
Cancellation Policy: When you have a scheduled appointment, that time slot is saved for you. Should you need to cancel or reschedule an appointment, please do so at least 24 hours in advance to avoid a charge for the session. In this way, clients who need an appointment will know that slot is available. For the first “no-show” there will be a charge of $75 (50% of my full regular fee). For any subsequent no-shows there will be a charge of the full fee of $150. No-show fees must be paid before or at the time of the next session. I understand that there are unforeseeable emergencies and illnesses, and I will, of course, take these into consideration.
I have read, understand, and agree to abide by the above policies and informed consent:
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Client Date