Professional Services Agreement

Initial Sessions & Assessment

Our first few sessions will involve an exploration of your unique situation, resources, challenges and opportunities. By then, I will be able to offer you a good idea of what our work together is likely to entail, and you will have had a chance to get a feel for me as well.

If you have questions about me or my practice, we should discuss them as they arise. If you are not comfortable working with me for any reason at all, no offense will be taken. Chemistry is important.

Fees & Billing

There should be no surprises on your monthly invoice from me. Depending upon the scope of the issues we address, we will probably start with a psychological test (MCMI-IV) and an extended interview that I will videotape and review in depth before we meet again.

Legal Proceedings: I do not conduct custody evaluations or forensic work; however, if you request my involvement in a legal proceeding or mediation, I will bill this time at the rate of $225 per hour, including travel and waiting time at court or other locations.

Taxes: For clients in New Mexico, I must add a state Gross Receipts Tax of 8.1875% to all my services. There is no tax on psychological services for televideo consultations outside of New Mexico.

Insurance Reimbursement

I do not accept insurance or belong to any preferred provider networks, although I can provide you with what is known as a "superbill" that you can submit to your insurance company if your program covers the services I provide.

This will require a formal clinical diagnosis, which I do not regard as helpful or necessary for most of my clients, and I make no guarantee that my services will be covered by your insurance or at what rate you might be reimbursed.

I will provide you with reasonable assistance in receiving the benefits to which you believe you are entitled, but you are responsible for the timely payment of my fees and for the management of your own insurance claims.

Contacting Me

I am not always immediately available by phone, email, or text messaging, although I check all of these regularly during business hours. My voicemail, email, and text messaging are confidential and accessible only to me, so feel free to leave me an informative message.

I will make every effort to return your call on the same day you make it. If you are difficult to reach, please give me some times when you will be available.

Professional Records

New Mexico and California law require that I keep records regarding certain aspects of our work together, and I may record notes or other information that goes beyond these requirements. I regard these records and all of our interactions as strictly private, confidential and privileged.

You are entitled to receive a copy of your records at any time. Note that even if you are paying for your son's or daughter's consultation, you will not have access to their records or to other information about our work together without their consent.

Minors

If you are under eighteen years of age, please be aware that New Mexico, California and Federal law may provide your parents the right to examine your treatment records under certain circumstances. New Mexico and California law permit me to deny your parents or guardians access to your records if I feel that is in your best interest.

I will generally take this position unless I have your permission to discuss something specific with your parents or another third party. If I feel there is a high risk that you will seriously harm yourself or someone else in the near future, I will notify your parents or appropriate authorities of my concern.

Confidentiality

Confidentiality is the foundation of effective personal counseling and psychotherapy. The privacy of all communications between a client and a psychologist is protected by law and by professional ethics. I will generally release information about our work to others only with your explicit permission.

Legal Exceptions: There are some situations in which I am legally obligated to take action to protect others from harm, even if I have to reveal some confidential information:

• If I believe that a minor, an elderly person, or a disabled person is being abused I may be required to file a report with an appropriate government agency.
• If I believe that a client is threatening serious bodily harm to another person in the immediate future I am required to take protective actions.
• If the client threatens to harm him or herself, I may be obligated to seek involuntary hospitalization or to contact family members or others who can provide protection.

I periodically consult with other professionals about various issues related to my clients. In consultation we make every effort to avoid revealing the identities of our clients, and my colleagues are legally bound to maintain the confidentiality of any information that I share with them.

Your Responsibility