Read Causal Factors in Behavior Problems text version

H. Denise Wooten, PsyD, P.A. Licensed Psychologist #2-4437 OFFICE SERVICES AND POLICIES (Effective 1-1-08) Services include psychological evaluations and individual and family therapy for children, adolescents, and adults. The diagnosis and treatment goals will be discussed with you by Dr. Wooten. Therapy is a joint effort between the therapist and client, the results of which cannot be guaranteed as progress depends on many factors including motivation, effort, and other life circumstances such as interactions with family, friends, and other associates. In undertaking therapy there are potential negative effects, which include, but are not limited to, increased stress in relationships and increased emotional distress. Implications or potential negative effects of a particular therapeutic technique may be discussed at any time with your therapist. Information you share with Dr. Wooten is confidential. However, by law, Dr. Wooten is required to notify appropriate authorities if you are evaluated to be a danger to yourself or others, or if you are a minor, elderly, or disabled and Dr. Wooten believes you are a victim of abuse or if you divulge information about such abuse. Additionally, Dr. Wooten is obligated by law to report sexual abuse by a therapist to authorities and licensing boards. Confidential information may also be required to be made available by court order in disputed custody or other legal matters. Other than these exceptions, information will not be released without written consent. Service charges for therapy and assessment are based on a 50-minute session. Session rates are determined by your placement on the sliding fee scale. Assessment charges will include additional time for scoring and interpretation of tests. Following psychological assessment, a written report may be needed to obtain further services from schools, physicians, or other agencies. Fees are $50 for a summary report and $200 for a comprehensive report. Missed appointments, unless due to emergency or illness, will be charged fees payable by the client: $25 for canceling without 24 hours' notice and $50 for failing to show without notification. This fee is automatically applied to the client's account at the time of the missed appointment. Insurance will not pay for missed sessions. Returned checks are subject to a $25 charge. Dr. Wooten does not accept assignment of insurance benefits other than for United Behavioral Health and Blue Cross/Blue Shield of Texas. Otherwise, clients can contact their insurance company to ascertain if they can self-file for out-of-network benefits.

Your signature below means you have read and agree to comply with these policies:

Date:

Signature:

Information

Causal Factors in Behavior Problems

1 pages

Report File (DMCA)

Our content is added by our users. We aim to remove reported files within 1 working day. Please use this link to notify us:

Report this file as copyright or inappropriate

1146050

You might also be interested in

BETA
Causal Factors in Behavior Problems