{"id":17,"date":"2016-02-25T18:55:13","date_gmt":"2016-02-25T18:55:13","guid":{"rendered":"https:\/\/drstacythomas.com\/consent-form\/"},"modified":"2020-02-04T19:22:34","modified_gmt":"2020-02-04T19:22:34","slug":"consent-form","status":"publish","type":"page","link":"https:\/\/drstacythomas.com\/consent-form\/","title":{"rendered":"Consent For Psych Services"},"content":{"rendered":"<div  class=\"tatsu-g6tsmsimry8jv302 tatsu-section    tatsu-clearfix\" data-title=\"\"  data-headerscheme=\"background--dark\"><div class='tatsu-section-pad clearfix' data-padding='{\"d\":\"90px 0% 90px 0%\"}' data-padding-top='90px'><div class=\"tatsu-row-wrap  tatsu-wrap tatsu-row-one-col tatsu-row-has-one-cols tatsu-medium-gutter tatsu-reg-cols  tatsu-clearfix tatsu-g6tsmsimuu18ov3v\" ><div  class=\"tatsu-row \" ><div  class=\"tatsu-column  tatsu-column-no-bg tatsu-one-col tatsu-column-image-none tatsu-column-effect-none  tatsu-g6tsmsimx69xmine\" data-animation=\"fadeIn\"   data-parallax-speed=\"0\" style=\"\"><div class=\"tatsu-column-inner \" ><div class=\"tatsu-column-pad-wrap\"><div class=\"tatsu-column-pad\" ><div  class=\"special-heading-wrap style1 oshine-module  tatsu-g6tsmsimzi3xvlog  \" data-animation=\"fadeIn\"  ><div class=\"special-heading align-center\"><h5 class=\"special-h-tag\" >CONSENT FOR PSYCH SERVICES<\/h5><hr class=\"separator margin-bottom\" \/><\/div><style>.tatsu-g6tsmsimzi3xvlog .sep-icon.oshine_diamond{background: #8fb7b6;}.tatsu-g6tsmsimzi3xvlog .separator{height: 2px;width: 40px;background: #8fb7b6;}<\/style><\/div><\/div><\/div><div class = \"tatsu-column-bg-image-wrap\"><div class = \"tatsu-column-bg-image\" ><\/div><\/div><\/div><style>.tatsu-row > .tatsu-g6tsmsimx69xmine.tatsu-column{width: 100%;}.tatsu-g6tsmsimx69xmine.tatsu-column > .tatsu-column-inner > .tatsu-column-overlay{mix-blend-mode: none;}.tatsu-g6tsmsimx69xmine > .tatsu-column-inner > .tatsu-top-divider{z-index: 9999;}.tatsu-g6tsmsimx69xmine > .tatsu-column-inner > .tatsu-bottom-divider{z-index: 9999;}.tatsu-g6tsmsimx69xmine > .tatsu-column-inner > .tatsu-left-divider{z-index: 9999;}.tatsu-g6tsmsimx69xmine > .tatsu-column-inner > .tatsu-right-divider{z-index: 9999;}.tatsu-g6tsmsimx69xmine.tatsu-column{transform: translate3d(0px,0px, 0);}<\/style><\/div><\/div><\/div><div class=\"tatsu-row-wrap  tatsu-wrap tatsu-row-one-col tatsu-row-has-one-cols tatsu-medium-gutter tatsu-reg-cols  tatsu-clearfix tatsu-g6tsmsipi07njpsx\" ><div  class=\"tatsu-row \" ><div  class=\"tatsu-column  tatsu-column-no-bg tatsu-one-col tatsu-column-image-none tatsu-column-effect-none  tatsu-g6tsmsipklgbif38\" data-animation=\"fadeIn\"   data-parallax-speed=\"0\" style=\"\"><div class=\"tatsu-column-inner \" ><div class=\"tatsu-column-pad-wrap\"><div class=\"tatsu-column-pad\" ><div  class=\"tatsu-module tatsu-text-block-wrap tatsu-g6tsmsipn1ch27gc  \"><div class=\"tatsu-text-inner tatsu-align-center tatsu-animate clearfix\" data-animation=\"fadeIn\"  ><style>.tatsu-g6tsmsipn1ch27gc.tatsu-text-block-wrap .tatsu-text-inner{width: 80%;text-align: left;}<\/style>\n<p dir=\"ltr\">\u00a0<\/p>\n<p dir=\"ltr\">Welcome.\u00a0 This form contains important information regarding our professional services and policies.\u00a0 Please read it carefully and make note of any questions you might have.<\/p>\n<p dir=\"ltr\">\u00a0<\/p>\n<p dir=\"ltr\"><strong>PSYCHOLOGICAL SERVICES<\/strong><\/p>\n<p dir=\"ltr\">Psychotherapy involves the use of psychological techniques to address mental, emotional and\/or behavioural problems.\u00a0 In our practice, we make use of techniques that have been studied scientifically and have been shown to work for most people seeking psychological treatment for a particular condition (e.g., depression, panic attacks).<\/p>\n<p dir=\"ltr\">You will find that our work is very focused and goal oriented. The first session will involve an assessment to help us understand the nature of your difficulties, your coping resources and strengths as well as your personal history.\u00a0 We will also discuss the treatment plan including the number of sessions it will likely require to achieve your goals. Most people generally begin to see improvement within the first 4 to 6 sessions.<\/p>\n<p dir=\"ltr\">There are several benefits to psychotherapy.\u00a0 These can include decreased distress, solutions to specific problems, improved self confidence, and improved functioning in important life roles.<\/p>\n<p dir=\"ltr\">However, there are also some risks.\u00a0 Given that therapy involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, anxiety, anger, guilt, or frustration. Sometimes those feelings may linger after the session.\u00a0 The aim of psychotherapy is to help you learn how to cope more effectively with those feelings so that they no longer overwhelm you.<\/p>\n<p dir=\"ltr\">There are no guarantees that treatment will work.\u00a0 But, if for some reason, you are not experiencing benefit within a reasonable time frame, the next step will be to discuss the options for getting your needs met.<\/p>\n<p dir=\"ltr\">\u00a0<\/p>\n<p dir=\"ltr\"><strong>SESSIONS<\/strong><\/p>\n<p dir=\"ltr\">Your first assessment session will be at least 60 minutes.\u00a0 Subsequent sessions will be 50 minutes; the remaining 10 minutes of the hour is used for necessary administrative tasks related to your treatment such as notes about the session, filling out forms, or phone calls on your behalf.<\/p>\n<p dir=\"ltr\">Typically, ongoing psychotherapy sessions are booked once\/week.\u00a0 As you make progress in treatment, the sessions tend to be spaced further (once every 2- 4 weeks) in order to monitor your progress and prevent relapse.<\/p>\n<p dir=\"ltr\">Every client at the Design Your Life Centre seeing an associate for services will meet with Dr. Stacy Thomas for at least 20 minutes to allow her to get to know them and understand their goals.\u00a0 After this initial meeting, clients will continue the assessment with their assigned therapist. In addition to monitoring progress by reviewing each client\u2019s test scores and their treating therapist\u2019s session notes, Dr. Stacy will continue to support and guide treatment during weekly supervision meetings.\u00a0<\/p>\n<p dir=\"ltr\">Once an appointment is scheduled, whether with me or my associate, you will be expected to pay for the full amount of the session unless you provide 24 hours notice of cancellation.\u00a0<\/p>\n<p dir=\"ltr\">\u00a0<\/p>\n<p dir=\"ltr\"><strong>PROFESSIONAL FEES<\/strong><\/p>\n<p dir=\"ltr\">Dr. Stacy\u2019s hourly rate is $225.\u00a0 The hourly rate for Dr. Stacy\u2019s associates is $200.<\/p>\n<p dir=\"ltr\">In addition to direct assessment and treatment sessions, we also charge our hourly rate for other services you may require such as report writing, completing forms, attending meetings with other health professionals that you have authorized, and telephone conversations lasting more than 15 minutes.\u00a0\u00a0<\/p>\n<p dir=\"ltr\">\u00a0<\/p>\n<p dir=\"ltr\"><strong>BILLING AND PAYMENT<\/strong><\/p>\n<p dir=\"ltr\">You will be expected to pay for each session by credit card, etransfer or cash at the end of the session.\u00a0 An invoice will be provided to you at the end of the session that you can later submit for reimbursement by your extended health insurance provider, where applicable.<\/p>\n<p dir=\"ltr\">In the event of a late cancellation, you will be invoiced for the full session.\u00a0 If the invoice is not paid within 30 days, we reserve the right to use legal means to secure payment.\u00a0 This may involve hiring a collection agency. In this case, we have the legal right to disclose your name, the nature of services provided and the amount due in order to collect overdue payment.<\/p>\n<p dir=\"ltr\">Occasionally extended health insurance providers request confirmation of when you attended appointments, the amount of time for the appointment and the fee for services.\u00a0 Your consent to treatment at the DYL Centre includes permission for us to confirm this basic information when asked by your insurer in order to facilitate their ability to verify your claim and reimburse you for our services.\u00a0\u00a0<\/p>\n<p dir=\"ltr\">\u00a0<\/p>\n<p dir=\"ltr\"><strong>CONTACTING US<\/strong><\/p>\n<p dir=\"ltr\">We are often not immediately available by telephone as we are often in session with clients during the day.\u00a0 It is always best to communicate via email or the Secure Messenger feature available through the patient portal which will be set up for you at the time of intake.\u00a0 You are also welcome to leave confidential voice mail. Both are monitored frequently and will make every effort to respond the same day.<\/p>\n<p dir=\"ltr\">In the case of an emergency, you should contact your family physician or proceed to the nearest emergency room.<\/p>\n<p dir=\"ltr\">\u00a0<\/p>\n<p dir=\"ltr\">\u00a0<\/p>\n<p class=\"text-align-center\" style=\"text-align: justify;\">\n<\/div><\/div><\/div><\/div><div class = \"tatsu-column-bg-image-wrap\"><div class = \"tatsu-column-bg-image\" ><\/div><\/div><\/div><style>.tatsu-row > .tatsu-g6tsmsipklgbif38.tatsu-column{width: 100%;}.tatsu-g6tsmsipklgbif38.tatsu-column > .tatsu-column-inner > .tatsu-column-overlay{mix-blend-mode: none;}.tatsu-g6tsmsipklgbif38 > .tatsu-column-inner > .tatsu-top-divider{z-index: 9999;}.tatsu-g6tsmsipklgbif38 > .tatsu-column-inner > .tatsu-bottom-divider{z-index: 9999;}.tatsu-g6tsmsipklgbif38 > .tatsu-column-inner > .tatsu-left-divider{z-index: 9999;}.tatsu-g6tsmsipklgbif38 > .tatsu-column-inner > .tatsu-right-divider{z-index: 9999;}.tatsu-g6tsmsipklgbif38.tatsu-column{transform: translate3d(0px,0px, 0);}<\/style><\/div><\/div><\/div><\/div><div class=\"tatsu-section-background-wrap\"><div class = \"tatsu-section-background\" ><\/div><\/div><style>.tatsu-g6tsmsimry8jv302 .tatsu-section-pad{padding: 90px 0% 90px 0%;}.tatsu-g6tsmsimry8jv302 > .tatsu-bottom-divider{z-index: 9999;}.tatsu-g6tsmsimry8jv302 > .tatsu-top-divider{z-index: 9999;}<\/style><\/div>\n","protected":false},"excerpt":{"rendered":"<p><a href=\"https:\/\/drstacythomas.com\/consent-form\/\" class=\"more-link style1-button\">Read More<\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"sfsi_plus_gutenberg_text_before_share":"","sfsi_plus_gutenberg_show_text_before_share":"","sfsi_plus_gutenberg_icon_type":"","sfsi_plus_gutenberg_icon_alignemt":"","sfsi_plus_gutenburg_max_per_row":"","passster_activate_protection":false,"passster_protect_child_pages":"","passster_protection_type":"password","passster_password":"","passster_activate_overwrite_defaults":"","passster_headline":"","passster_instruction":"","passster_placeholder":"","passster_button":"","passster_id":"","passster_activate_misc_settings":"","passster_redirect_url":"","passster_hide":"no","passster_area_shortcode":"","footnotes":""},"_links":{"self":[{"href":"https:\/\/drstacythomas.com\/wp-json\/wp\/v2\/pages\/17"}],"collection":[{"href":"https:\/\/drstacythomas.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/drstacythomas.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/drstacythomas.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drstacythomas.com\/wp-json\/wp\/v2\/comments?post=17"}],"version-history":[{"count":5,"href":"https:\/\/drstacythomas.com\/wp-json\/wp\/v2\/pages\/17\/revisions"}],"predecessor-version":[{"id":1129,"href":"https:\/\/drstacythomas.com\/wp-json\/wp\/v2\/pages\/17\/revisions\/1129"}],"wp:attachment":[{"href":"https:\/\/drstacythomas.com\/wp-json\/wp\/v2\/media?parent=17"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}