CLINICAL SERVICES: I provide personality testing plus individual and couples counseling. These services are described on my website above. The following pages can be accessed on “WORK WITH ME”, where you will see and can download this “Permission to Treat”.
MEETINGS: After you’ve returned this form to me, you can set up your first appointment with me over the phone. The first session will be 75 minutes long and most others 60 minutes.
PROFESSIONAL FEES: Sessions cost $180 for one-hour appointments on weekdays that start before 5 PM. $270 is the fee for sessions during evenings and weekends. The first session costs $270 because it lasts 75 minutes and includes several communications and future privileges. Costs of personality testing are listed on my website.
BILLING AND PAYMENTS: Sessions are paid at time of service by cash, check, or Venmo. Credit cards including HSA’s can also be used, subject to a $5 fee per transaction to cover my costs. Except for illness or unsafe roads, to avoid the late cancel charge of $90, cancellations need to be sent to me by text or voicemail by end of the day before your session. All fees are to be paid at time of service, and my services are not eligible for any insurance reimbursement.
CONTACTING ME: Your fees pay for 15 minutes per week of my spontaneous (unscheduled) time with your phone calls, texting, and emailing while we are regularly working together. Unscheduled means don’t ask me, “May I have my 15 minutes now?” To find out, just text or call me whenever you like. I will respond immediately if I can, and at my first convenience if I can’t, almost always within half a day (not if I’m out of town on vacation). If you feel you are unable to wait for me to return your call, contact your family physician, the nearest emergency room, or the local mental health hotline.
CONFLICTS OF VALUES: Research has consistently shown that people get more out of counseling when they have chosen a counselor who shares their values and beliefs. Mine are stated on my website (see mynewlife.com/values-and-beliefs), so that your signing this permission to treat acknowledges you want those to guide your decisions on how to live. I teach what makes us and others feel and do better now and in the long run. My own research confirms what has been widely proven and presented on my website, that living by traditional moral values is good for your physical, emotional, mental, and family health. For me, there is no conflict between choices that make you and others healthy, and choices that make you and others holy, as the Bible consistently teaches that following its principles will make life go better for you and others. We will follow Jesus’ two commandments with each other.
CONFLICTS OF INTEREST: I make my therapeutic alliances with the soul of my client. Unlike the ego/flesh (the naturally self-made and selfish self), the freely choosing soul is the only part of any person who can take care of one’s relationships, responsibilities, and realities, one’s beliefs, feelings, and habits, one’s marriage and children, one’s body and bank account, one’s genitals and gender expressions, one’s faith in God. The certifying boards I have previously answered to ally with my clients’ egos, as their lawyers do. That’s why it would be a conflict of interest for them (though not for me) for me to work with a husband for his well-being and also with his wife for hers, or with their marriage or family for theirs. I no longer carry malpractice insurance, because we will answer to a spiritual authority higher than a court of law or a state board about how we treat each other (see I Cor. 6:1-8). If you ever feel that I am mistreating you, at no charge to you, in the spirit of Matthew 18:17-19, I will in spiritual mediation, hear you out and submit to the direction of whoever is the pastor, elder, or mediator of your choice, who shares our values and beliefs, and with your agreement, can determine whether and how I will continue to counsel you.
CONFIDENTIALITY: In general, all our communications including whether you’ve seen me is private, between us. I will only release information about our work to others with your written permission. But there are a few exceptions:
If you sign a release directing me to do so, or if a judge or court order requires me to;
If I am told that someone has been or may be abused or neglected without it being reported; If you tell me that you or someone else poses a serious threat for physically harming someone, or If you confess to me that you or someone else has committed an unreported crime.
Emergencies and Teletherapy: If I feel that an emergency such as those in the four previous lines above may occur or may have occurred, I will report this. Any teletherapy sessions will be through a private telephone and video conferencing service (Zoom), where our messages and pictures are protected with encryption (scrambled at each end, so they cannot be intercepted).
Social Media: I won’t give or receive contact with you on social media, as it’s not private.
My possible need to discuss transferring your case: If I ever believe you need to work with another therapist instead of me, you release me to discuss our sessions with a consulting licensed counselor of my choice, and we both agree to follow the directives of this counselor.
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Now please open this form/document, read it, and call or text me if there’s anything that seems confusing, difficult, or unfair to you. Of course I won’t give or sell this info to anyone, but by digitally entering the four pieces of information below, you acknowledge that you’ve agreed to these as terms for our working together.
Your name: Cell phone(s) I can use:
Email(s) I can use to reach you: Today’s date:
Once this information is entered, save this new document with your info on it, and email it back to me as an attachment, to [email protected]. Then we can set the time for our first appointment, and be ready to go when our first session begins. Thank you, and I look forward to working with you.