HOPE HAPPENS, LLC
Pastoral Counseling Ministry
POLICY STATEMENT
Please read this policy carefully and feel free to ask me any questions
In order to better serve you, I would like to provide you with information about this counseling service. This policy statement establishes the conditions of our therapeutic relationship.
Fee Schedule: Office: The intake is one and one-half hours and the fee is $250.00 for individuals and couples. The standard individual fee is $150.00 per hour session. The standard fee for couples and/or family counseling is $185.00 per hour session. Dr. Graves will determine, during the intake process, if testing is indicated, for an additional fee. Results of any testing will be reviewed at your next scheduled session. Dr. Graves may administer a temperament analysis, or other indicated psychometric testing. Testing serves as a valuable therapeutic tool to facilitate a more effective and efficient counseling session for our work together. Phone counseling sessions are available.
Telephone calls, reports or letters prepared on your behalf will be determined on a prorated basis. The standard fees apply for work outside of the Hope Happens office, including hospital or home visits. Mileage and travel time may be applicable.
Payment Policy: Credit card payment is acceptable. Local checks may be made payable to “Hope Happens.” Returned checks are subject to a $35.00 fee.
Cancellation Notice: If you are unable to keep your appointment time, please give at least 24 hours advance notice. My telephone number is (410) 520-0319. The regular hourly fee will be charged without 24 hour notice for cancellation scheduled sessions.
Session Hours: Office hours are by appointment only. I have daily, evening, and Saturday appointments available.
Emergency Service Policy: If you have an emergency situation and are unable to reach me, please call 911, or go to a Hospital emergency room.
In the event of an emergency, whom shall I contact:
Emergency Person:-________________________________
Home phone:_______________ Cell:______________________________
Confidentiality Policy: All therapeutic communications, records and contact with Dr. Graves will be held in strictest confidence. Information may be released, in accordance with state law, only when the client signs a written release of information indicating informed consent to such release; or if the client expresses serious intent to harm himself/herself or someone else; or there is evidence or reasonable suspicion of abuse against a minor child, elderly person (sixty five years or older), or dependent adult; or a subpoena or other court order is received directing disclosure of information. It is my policy to assert either privileged communication in the event of a court order or subpoena or to pursue the right to consult with clients, if at all possible barring an emergency, before mandated disclosure is required. Although Hope Happens cannot guarantee it, I will always endeavor to apprise clients of all mandated disclosures.
Please do not disclose information about another client you may see at my office who is also receiving counseling. Such disclosures may jeopardize the safety and well-being of that person or family member(s). If such disclosure occurs, you may encounter legal action from that party and you may be terminated, by Dr. Graves, from Hope Happens.
The Counseling Process: The counseling process may involve focusing on resources, solutions and strategies to deal with your presenting problem. While I may ask you about many areas of your life, the focus of counseling will be on working toward your specific goals. Participation involves discussing your concerns openly, completing assignments (if any), and providing feedback to Dr. Graves about the progress of the counseling.
In counseling, you risk learning things about yourself or your relationships that you may find painful. Often growth cannot occur, until you confront issues that cause you discomfort. We will be there to support you in the process of achieving your goals, but there is a risk that counseling may not be sufficient by itself. We will explore alternative plans with you, upon determination of your needs.
I have carefully read and fully understand this policy statement. I acknowledge that I have received information about the counseling I am considering. I have had all my questions answered fully. I do hereby seek and consent to take part in this counseling with Dr. Patricia Graves. I understand that no promises have been made to me as to the results of our counseling together or of any techniques utilized by Dr. Graves.
I am aware that I may stop counseling with Dr. Graves at any time. I am responsible for any services rendered.
___Check the box that you accept these terms . I understand and agree with all of these statements.
I understand that I am entitled to a copy of this consent. I do not wish a copy.________