Dr. Scott Private Client Information Sheet and Agreement
Greetings!
Congratulations on taking charge of your life! Here is some basic information about how Dr. Scott's psychotherapy and hypnotherapy services work.
Insurance
Dr. Scott no longer bills or accepts insurance of any kind, but for those clients with insurance, most are able to seek reimbursement and have all or most fees paid back directly to them. The client pays for the session prior to the service by credit card, check, PayPal or cash and they are given what's called a "Superbill" that documents the session. This document is then submitted to the insurance company for reimbursement.
Of course, each health plan varies so please call the number on the back of your insurance card to get their particular procedure prior to scheduling your first appointment. In some cases, they will ask us to complete some paperwork as well.
Please understand that receiving a superbill is not a guarantee of repayment and our office is unable to bill the insurance company on your behalf.
Fees
The initial session fee is $300 and the session lasts usually an hour. Follow up sessions are $150 and last anywhere from 45 minutes to an hour depending on what we're involved in. All major credit cards, PayPal, checks and cash are accepted. If you have a Healthcare Spending Account (HSA), those cards are accepted for payment in full as well. The Staff will ask you for a major credit card to keep on file before your first appointment, so please have that ready when you call.
Phone/Skype Sessions
Dr. Scott is able to work this way and the same fees apply as an in office appointment.
Home Visits
If you'd like to be seen in your own home, Dr. Scott is able to do that. The fee for this service is $300 per hour or quarter hour fraction thereof (one hour minimum). There is no additional charge for travel time or mileage if you live within the Las Vegas Metro Area.
Scheduling, Cancellations and Missed Appointments
Once you schedule an appointment with us, that time is reserved just for you. We don't overbook and we will always do our best to be on time. If something comes up and you are unable to keep your appointment, please notify us at least One Week in advance. This way, we can fill that spot with someone on the waiting list.
Additionally, if you'd like to be placed on the waiting list for a particular day and time, please let us know. It generally takes a few weeks to get in the rhythm of a recurring appointment.
Failure to give us One Week notice will result in your credit card being charged for that session, if we are unable to fill the spot. To schedule your first appointment, you will be asked to provide us with a credit or debit card for us to keep on file. We will have you complete a separate credit card authorization form that we will file securely on your behalf. If you’d like to use PayPal, this is fine, and we will still require you to have a valid credit card on file with us. PayPal payments are best made the day before your session to avoid inadvertent double billing.
How many sessions will I need?
A common question and although everyone is different, there are some trends we’re noticing in duration of treatment episodes:
Smoking Cessation - 3-5 sessions
Weight Loss - 10-26 sessions
Addictions – 6-12 sessions
Depression/Negative Emotions - 6-10 sessions
Anxiety - 3-5 sessions
Couples Counseling - 5-10 sessions
PTSD/Trauma Recovery - 12-30 sessions
Eating Disorders - 6-12 sessions
Anger Management - 6-12 sessions
Phobias/Habit elimination - 2-3 sessions
ADHD/Attention & Concentration Issues - 6-10 sessions
Self-Esteem - 3-6 sessions
And, as with all things, individual results may vary.Thanks again for your interest!
I have read the above, understand and agree to these policies.
Client Signature:
X ______Date:______
Print Name:______