Bonnie L. Goetz

MA, LPC

Current Degrees/ Credentials

BA in Psychology from University of Northern Colorado, 1995

MA in Psychology/ Counseling from Chapman University, 2000

Licensed Professional Counselor (#3127), 2002

Welcome to My Practice!

This document contains important information about my professional services and business policies. Please read each page carefully and jot down any questions you might have so that we can discuss them. The following information and policies are meant to be protective of us both.

PSYCHOTHERAPY: BENEFITS AND RISKS

Psychotherapy can have benefits and risks. Since therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness and helplessness. On the other hand, psychotherapy has also been shown to have long-term benefits for those who go through the process. Therapy often leads to better relationships, solutions to specific problems, and a significant reduction in feelings of distress. Still, there are no guarantees regarding what you will experience. Mental health treatment is not a cure and may not necessarily prevent suicide or suicidal behavior.

DISCLOSURE:

The practice of licensed or registered persons in the field of psychotherapy is regulated by the Mental Health Licensing Section of the Division of Registrations. The Board of Examiners can be reached at:

Mental Health Licensing Section of the Division of Registrations

1560 Broadway, Suite #1350

Denver, Colorado 80202

(303) 894-7800

As to the regulatory requirements applicable to mental health professionals: a Licensed

Clinical Social Worker, a Licensed Marriage and Family Therapist, and a Licensed

Professional Counselor must hold a masters degree in their profession and have two years of

post-masters supervision. A Licensed Psychologist must hold a doctorate degree in

psychology and have one year of post-doctoral supervision. A Licensed Social Worker must

hold a masters degree in social work. A Psychologist Candidate, a Marriage and Family

Therapist Candidate, and a Licensed Professional Counselor Candidate must hold the

necessary licensing degree and be in the process of completing the required supervision for

licensure. A Certified Addiction Counselor I (CAC I) must be a high school graduate, and

complete required training hours and 1000 hours of supervised experience. A CAC II must

complete additional required training hours and 2,000 hours of supervised experience. A

CAC III must have a bachelors degree in behavioral health, and complete additional required

training hours and 2,000 hours of supervised experience. A Licensed Addiction Counselor

must have a clinical masters degree and meet the CAC III requirements. A Registered

Psychotherapist is registered with the State Board of Registered Psychotherapists, is not

licensed or certified, and no degree, training or experience is required.

Clients can seek a second opinion from another therapist or terminate therapy at any time. It is requested that if you decide to terminate, this decision will be shared during a therapy session so that we may discuss your decision and appropriate recommendations and referrals can be made.

In a professional relationship, sexual intimacy is never appropriate. If sexual intimacy occurs, it should be reported to the Department of Regulatory Agencies, Mental Health Section (contact information is listed above).

Generally speaking, the information provided by, and to, a client during therapy sessions is legally confidential. This means that I cannot be forced to disclose information without client consent. Information disclosed in sessions is privileged communication and cannot be disclosed in any court of competent jurisdiction in the State of Colorado without the consent of the person to whom the testimony sought relates. There are exceptions to the general rule of legal confidentiality. These exceptions are listed in the Colorado statues (C.R.S. 12-43-218). Be aware that provisions concerning disclosure of confidential communications shall not apply to any delinquency or criminal proceedings, except as provided in section 13-90-107 C.R.S. There are exceptions that I will identify to you as situations arise in therapy.

GENERAL INFORMATION:

Session Information:

  • Our First Few Sessions: Our first few therapy sessions (2 to 4 sessions) will involve an evaluation of your needs. During this time you should carefully consider whether or not my skills, experience, and personal manner are a good fit for you. Similarly, the initial evaluation process will allow me to determine whether my skills and experience are well suited for you and the problems you are facing, or whether you should be referred to another therapist (perhaps one with more specialized training in your personal mental health situation).
  • Cancellation and No Show Policy: I understand that there are times that things come up which make late cancellations and/or absences unavoidable, such as lack of child care, weather, car problems, illness, plane delays, etc. I give everyone a “pass” on one missed or late cancelled appointment because I know that things do come up. After that, you will be charged $50 for less than 24 hours notice. However, if you do give me less than 24 hours notice and I am able to fill your appointment time, you will not be charged. Please note that your insurance company DOES NOT cover late cancellation/ no show charges.
  • Late arrival: If you are more than 20 minutes late for your appointment, please expect to be asked to reschedule and charged the late cancellation fee.
  • Session Length: Sessions are between 45 and 50 minutes. I adhere to this schedule out of respect for all of my clients’ time. If you feel you may have difficulty structuring the session to allow enough time to address your issues, please let me know and we can make this concern a focus of our treatment.

Payment:

  • Your first evaluation session: $95, sessions thereafter (50minutes): $90 unless we have made other arrangements based on your income.
  • Unless prior arrangements have been made, payment is due at the time services are rendered.
  • If collection action is necessary, understand that you are responsible for payment of all the expenses of collecting your unpaid account, including attorney’s fees. Also understand that you specifically relinquish your privilege of confidentiality that may be necessary to process your account for collection.

IF YOU PLAN ON USING HEALTH INSURANCE:

  • As a courtesy, I will submit your bills to your insurance company if you prefer.
  • You are financially responsible for charges not covered by insurance, including initial sessions requiring preauthorization. It is my experience that insurance companies do not always cover their members like they say they will. It is your responsibility to know and understand your policy as well as to follow up with your insurance company regarding any problems that might occur regarding getting your sessions paid for.
  • I do not do secondary insurance billing. I will, however, provide you with a billing statement that you can submit to your insurance company to request reimbursement.
  • When you request that I bill your insurance company for your services, you are authorizing payment directly to me of the benefits otherwise payable directly to you under the terms of your insurance.

Between Session Contact:

  • I return phone calls as soon as I can within one business day.
  • If you contact me by email, please know that at times I may check my email infrequently and therefore may not receive your message as soon as you would like.
  • Please note, I do not do phone therapy and prefer that you to schedule an appointment with me if you wish to speak to me and you believe it will take more than a couple of minutes.

Letter Writing and Reports:

  • Letters and reports are charged at the normal session rate of $90/ hour. I usually need 2-3 weeks notice for any letters, reports or copies of anything out of your file.

After hours Emergencies:

  • In the case of emergency, please call 911 immediately or go to the nearest emergency room to be evaluated. (720) 648-1550 is my emergency phone number reserved for extremely urgent issues such as needing direction to a psychiatric hospital, or a psychiatric hospital needing immediate information. Otherwise I DO NOT OFFER BETWEEN SESSION CRISIS PHONE CALLS. If you feel this is a service you are likely to need as a part of your course of treatment, please let me know so we can discuss alternatives such as community resources, or possibly a referral to another provider who does offer such services.

Confidentiality and Release of your Protected Health Information:

  • Many insurance companies use the services of managers to monitor the use of mental health benefits for the people they insure. In order for you to use your benefits it may be necessary for me to provide a detailed disclosure of your record to a case manager or other employee of a managed care or insurance company. Managed care organizations usually require a psychological diagnosis and frequent reports about your symptoms, history and progress in order for me to get authorization for you to continue treatment.
  • I will use information that identifies you, including information concerning your diagnosis, services provided to you, dates of service, services needed by you to your insurance company as well as to my billing service in order to obtain payment for services.
  • I may use your information to plan treatment and consult with other health care professionals concerning services needed or provided to you. However, my policy is to get your consent before I release any information to another health care provider.
  • Except for certain minors, protected health information cannot be provided to family members without the client’s consent. In situations where family members are present during a discussion with the client, and it can be reasonably inferred from the circumstances that the client does not object, information may be disclosed in the course of that discussion.
  • I do use a cell phone, fax and email, all of which have the capacity to be intercepted. Please inform me if this is a concern to you and I will use only my landline when I contact you.

Legal Responsibilities:I am required by law to report to the appropriate agency (law enforcement, Department of Human Services, mental health services) when:

  • child/ elder abuse or neglect is reported.
  • court ordered to release information.
  • there is a legal duty to warn of a threat that a client has made of imminent physical violence. I am required to notify the potential victim of the threat and to report it to law enforcement.
  • a client is imminently dangerous to herself/ himself or to others, or is deemed gravely disabled.
  • there has been a threat to the national security of the United States.

Litigation: If you are involved in a divorce or custody litigation, please understand that my role as a therapist is not to make recommendations for the court concerning custody or parenting issues or to testify in court concerning opinions on issues involved in the litigation. Experience has shown that testimony by therapists in domestic cases causes damage to the clinical relationship between a therapist and client; therefore I will not appear as a witness in any such litigation. Only court-appointed experts, investigators, or evaluators can make recommendations to the court on disputed issues concerning parental responsibilities and parenting plans.

I have read the preceding information, it has also been provided verbally, and I understand my rights as a client or as the client’s representative:

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