Terms of Service

I understand that the service provided through Phoenix Inspirations, LLC is not intended for crises and urgent needs.

In a crisis situation, I agree to call 988 or local emergency services or visit the nearest emergency room.

Informed Consent for Therapy Agreement

Please read through the following informed consent agreement. What follows is a basic understanding between the client and therapist. In general, what is listed below are the responsibilities and obligations of your therapist and also some expectations of you as the client. This document also contains important information about professional services and business policies. At our first session, I will need to get you general information that you'll need for proper identification and emergencies, including full name, address, contact information, and an emergency contact with a phone number. When you sign this document in the new client paperwork, it will represent an agreement between us.

Counseling

Voluntary Participation: All clients voluntarily agree to treatment and may terminate at any time without penalty. In the first couple of sessions, you should decide whether this therapy is right for you. If you feel it is not a good match, I will be happy to assist you in finding a new therapist.

Client Involvement: All clients are expected to show up to the appointments on time, be prepared to focus on and discuss therapy goals and issues, and will not attend while under the influence of mood-altering chemicals. All clients should be open and honest so I can help you with your goals. Counseling is not like a medical doctor visit. Instead, it calls for a very active effort on your part. For therapy to be most successful, you are encouraged to work on things we talk about both during our sessions and at home. Inconsistent attendance can negatively affect your therapy progress.

Therapist Involvement: I will be prepared at the designated times (barring emergencies), and will be attentive and supportive in meeting the therapy goals and do everything possible to assist you in achieving a greater sense of self-awareness and work toward helping you resolve problem areas.

Guarantees: Although most people get better in therapy, some do not. I do not guarantee results as it is impossible to guarantee to become happier, saving marriages, stopping drug abuse, becoming less depressed, and so forth.

Risks of Therapy: Just as medications sometimes cause unexpected side effects, counseling can stimulate painful memories, unanticipated changes in your life, and uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. Another risk of therapy is that through the process of therapeutic change, it is not uncommon for clients to reach a point of change where they may feel they are different and no longer able to be the same person they were upon entering therapy. At times, these feelings can be unsettling.

Benefits of Therapy: Therapy can provide a higher level of functional coping solutions to specific problems, new insights into self, more effective means of communicating in relationships, symptomatic relief, and improved self-esteem. Alternatives to traditional therapy can include stress management, twelve-step programs, peer self-help groups, bibliotherapy, mindfulness, and support groups.

Credentials and Qualifications: I hold a Master's degree in Clinical Mental Health Counseling and am currently pursuing my PhD in Social Psychology. I am a Licensed Professional Counselor licensed by the State of Georgia to provide counseling based on my training and education.

Counseling Approach & Theory. I use a variety of therapy approaches based on the client's needs, strengths, and abilities, which includes a Cognitive-Behavioral and Humanistic orientation to counseling. I will focus largely on building a relationship with clients, creating a nurturing environment conducive to change, exploring past events and how they continue to affect you today, analyzing underlying belief systems and their relation to inadequate functioning or hindrance to change, and implementing specific emotional, cognitive, and behavioral techniques designed to aid in change toward specified goals.

Colleague Consultation: In keeping with standards of practice, I may consult with other mental health professionals regarding the care and management of cases. The purpose of this consultation is to ensure the quality of care. I will maintain complete confidentiality and protect your identity by not using real names or any identifying information.

Meeting and Length of Therapy: Once we have agreed to work together, we will usually schedule one appointment every 1 - 2 weeks at an agreed-upon time. The session length, in most instances, is 55 minutes. Because our meetings are your time, you are expected to come to each session with a sense of what it is you would like to discuss or work on during that particular session. The length of therapy is quite variable based on client motivation, the number and severity of issues to resolve, and work efforts outside of the therapy sessions. My current schedule is Monday, Tuesday, and Wednesday from 8 a.m. to 6 p.m.

Confidentiality and Privilege: The information and content shared in therapy will remain confidential, except as noted in the next section: Exceptions to Confidentiality and Privilege. Your information will not be shared with anyone without your written consent. Your information is also privileged, which means that I am free from the duty to speak in court about your counseling unless you waive that right or a judge orders it.

EXCEPTIONS TO CONFIDENTIALITY AND PRIVILEGE

As a mandated reporter in the state of Georgia, I am legally obligated to violate confidentiality under the following circumstances: * When the therapist has reason to suspect that the client has been, or is currently, involved in the abuse or neglect of a child * When the therapist has reason to suspect that the client has been, or is currently, involved in the abuse or neglect of vulnerable adults * If a client is pregnant and taking street drugs * If the client is a serious danger to themselves, i.e., if suicidal * If a client is a serious danger to someone else, i.e., if homicidal * If the courts order copies of records

Ethical Guidelines: I follow the American Counseling Association (ACA) ethical guidelines and those dictated in the Georgia Licensing Board rules and regulations. Copies of these materials are available on the organization's website. (www.counseling.org; www.sos.ga.gov).

Therapeutic Records: The laws and standards of this profession require that I keep treatment records. You are entitled to receive a copy of the records unless we think that seeing them would be emotionally damaging. In this case, we will send them to a mental health professional of your choosing. Because these are professional records, they can be misinterpreted and/or upsetting to untrained readers. We recommend you review them in that therapist's presence so they can discuss the contents. All client records include a data sheet required to be filled out before therapy (Full Name, address, Date of Birth, home/cell phone number, and emergency contact name and number), a chronological listing of appointments, a copy of signed releases, copies of any correspondence regarding your case, a copy of the signed informed consent packet materials, and a copy of all therapy notes. This therapist will maintain all records in a secured area for a period of seven years from the time of service termination. You have a right to contest material in your records, which will be duly noted. You do not have a right to alter your records or dictate information be removed. You have the right to access and view your record, but you do not own the records. They are the property of the therapist.

Supporting Vendors: While operating as a therapist, I contracted with an external vendor to use an electronic health record (EHR) (iCANotes) and for credentialling with insurance companies and billing (Headway and Grow Therapy). These vendors comply with all regards with HIPAA guidelines and understand confidentiality. They agree to abide by those regulations as set forth and maintain the same level of confidentiality that healthcare professionals are bound to in the event they encounter client information. Their systems are electronically automated, and the EHR vendor, like most EHR vendors, has restricted access and cannot access patient narrative notes.

Professional Fees: All session fees are managed through third party billing agents, and any questions or concerns regarding this should be addressed to them.

Phone Availability: I am often not immediately available by phone. Because of other obligations, sessions, or groups, I typically will only return emergency phone calls in the evening. You can leave messages for me on my phone, or through email, and make every effort to return your call the same day you have messaged/called, except for some weekends and holidays. Phoenix Inspiration, LLC is not intended for crisis situations and urgent needs. In a crisis situation, I agree to call 988 or local emergency services or visit the nearest emergency room.

Emergency & Interruption of Therapy: In case of an emergency, when on vacation, or when planning to be unavailable for a short period of time, I will give you the information for another therapist you can contact with questions or see as needed. In the event of a longer interruption of therapy, I will make appropriate referrals as needed.

Termination: Either the client or I may end therapy at any time. Your voluntary involvement allows you to discontinue at any time. If you appear to no longer benefit from therapy or if there is a conflict in values, then I may discuss termination. If you would like more counseling, I will give you a competent referral to help you address your issues.

Client Satisfaction Survey: I welcome feedback about the services you receive, and I am dedicated to improving service delivery to clients. You may receive a request to complete a satisfaction survey at various times, and I urge you to complete it.

Encounters outside of the Therapeutic Setting: If at any time we run into each other in the community. I will protect your confidentiality by not speaking to you or acknowledging you. If you wish to talk with me, you can initiate that contact. If you wish to talk with me, I will keep our encounter as brief as possible. In addition, ethical guidelines discourage social or business interactions between counselor and client outside of the context of therapy. While I care deeply about working with you, I am not in a position to be your friend or have any social or personal relationship with you. Any gifts bartering and/or trading for service is not considered appropriate and will not be engaged in.

NOT ALL forms of communication are considered confidential. I prefer not to communicate through mobile/cell phone, text messaging, or social media sites like Facebook, Twitter, and LinkedIn. These sites are not secure and may compromise your confidentiality. If you decide to engage in these forms of communication, I assume you are aware of and accept the possible risk to privacy through this form of communication. I will only reply to direct you to another platform based on the situation for further communications.

Notice of Privacy Practices

Notice of Therapists’ Policies and Practices to Protect the Privacy of Your Health Information

THIS NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. 

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I. Uses and Disclosures for Treatment, Payment, and Health Care Operations

Your therapist may use or disclose your protected health information (PHI) for treatment, payment, and health care operations purposes with your consent. To help clarify these terms, here are some definitions: 

  • “PHI” refers to information in your health record that could identify you.

  • “Therapist” refers to any licensed mental health professional.

  • “Treatment, Payment and Health Care Operations”

** Treatment is when your therapist provides, coordinates, or manages your health care and other services related to your health care. An example of treatment would be when your therapist consults with another healthcare provider, such as your family physician or another psychotherapist.

** Payment is when your therapist obtains reimbursement for your healthcare. Examples of payment are when your therapist discloses your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.

** Health Care Operations are activities that relate to the performance and operation of this practice. Examples of healthcare operations are quality assessment and improvement activities, business-related matters, such as audits and administrative services, and case management and care coordination.

  • "Use" applies only to activities within this practice, such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.

  • "Disclosure" applies to activities outside of this practice, such as releasing, transferring, or providing access to information about you to other parties.

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II. Uses and Disclosures Requiring Authorization

Your therapist may use or disclose PHI for purposes outside of treatment, payment, or healthcare operations when your appropriate authorization is obtained. An "authorization" is written permission above and beyond the general consent that permits only specific disclosures. In those instances when your therapist is asked for information for purposes outside of treatment, payment, or healthcare operations, your therapist will obtain authorization from you before releasing this information. Your therapist will also need to obtain authorization before releasing your psychotherapy notes. "Psychotherapy notes" are notes your therapist may have made about your conversation during a private, group, joint, or family counseling session, which have been kept separate from the rest of your medical record. These notes are given a greater degree of protection than PHI.

You can just revoke all these authorizations (of PHI or psychotherapy notes) at any time if you've received each revocation. You may not revoke an authorization to the extent that (1) your therapist has relied on that authorization or (2) the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insurer the right to contest the claim under the policy. 

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III. Uses and Disclosures with Neither Consent nor Authorization

Your therapist may use or disclose PHI without your consent or authorization in the following circumstances:

  • Child Abuse: If your therapist knows or has reason to believe a child is being or has been neglected or abused or that a child has been threatened with neglect or abuse that is likely to occur, he or she must immediately report the information to the relevant county department, police, or sheriff's department.

  • Vulnerable Adult Abuse:  If your therapist has reason to believe that a vulnerable adult is being or has been maltreated, abused, or neglected or has knowledge that a vulnerable adult has sustained a physical injury that is not reasonably explained, your therapist must immediately report the information to the appropriate agency in this county. Your therapist may also report the information to a law enforcement agency.       

**Vulnerable Adult means a person who, regardless of residence or whether any type of service is received, possesses a physical or mental infirmity or other physical, mental, or emotional dysfunction (i) that impairs the individual's ability to provide adequately for the individual's own care without assistance, including the provision of food, shelter, clothing, health care, or supervision; and (ii) because of the dysfunction or infirmity and the need for assistance, the individual has an impaired ability to protect the individual from maltreatment.

  • Health Oversight: If the Wisconsin Department of Regulation and Licensing requests that your therapist releases records to them in order for the appropriate examining board to investigate a complaint, he or she must comply with such a request.

  • Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about your diagnosis and treatment and the records thereof, such information is privileged under state law, and your therapist will not release the information without written authorization from you or your personal or legally-appointed representative, or a court order. This privilege does not apply when you are being evaluated by a third party or where the evaluation is court-ordered. You will be informed in advance if this is the case.

  • Serious Threat to Health or Safety: If your therapist has reason to believe that you may cause harm to yourself or another person, he or she must make a reasonable effort to warn the third party (if any) and/or contact law enforcement.

  • Worker’s Compensation: If you file a worker’s compensation claim, your therapist may be required to release records relevant to that claim to your employer or its insurer.

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IV. Patient’s Rights and Therapist’s Duties

Patient’s Rights:

  • Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of protected health information. However, your therapist is not required to agree to a restriction you request.

  • Right to Receive Confidential Communications by Alternative Means and at Alternative Locations: You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. For example, you may not want a family member to know that you are seeing a therapist. On your request, your therapist will send your bills to another address.

  • Right to Inspect and Copy: You have the right to inspect or obtain a copy (or both) of PHI in the mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. On your request, your therapist will discuss with you the details of the request and denial process.

  • Right to Amend: You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. Your therapist may deny your request. On your request, your therapist will discuss with you the details of the amendment process.

  • Right to an Accounting: You generally have the right to receive an accounting of disclosures of PHI regarding you. On your request, your therapist will discuss with you the details of the accounting process.

  • Right to a Paper Copy: You have the right to obtain a paper copy of this notice from your therapist upon request, even if you have agreed to receive the notice electronically.

Therapist’s Duties: 

  • Your therapist is required by law to maintain the privacy of PHI and to provide you with a notice of his or her legal duties and privacy practices with respect to PHI.

  • Your therapist reserves the right to change the privacy policies and practices described in this notice. Unless he or she notifies you of such changes, however, your therapist is required to abide by the terms currently in effect.

  • If your therapist revises his or her policies and procedures, you will be provided with a copy of the revised version at your next scheduled therapy session. 

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V. Complaints

If you are concerned that your therapist has violated your privacy rights, or you disagree with a decision made by your therapist about access to your records, you may further discuss this with your therapist. You may send a written complaint to the Secretary of the U.S. Department of Health and Human Services at www.hhs.gov/ocr/privacy/hipaa/complaints or the applicable state board of your therapist. 

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VI. Effective Date, Restrictions, and Changes to Privacy Policy 

This notice is effective January 1, 2025. Phoenix Inspirations, LLC reserves the right to change this notice's terms and make the new notice provisions effective for all PHI it maintains. If this should take place, Phoenix Inspirations will provide you with a revised notice by posting a revised copy in a prominent place online and making the revised copy available on our webpage: www.risemightyphoenix.com