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Tuscaloosa Christian Counseling

Melissa Hager

Practice Statement and Disclosures for 2013

Thank you for selecting this office for your counseling services. As a counselor, my primary goal is to provide professional and effective counseling services according to both your requests and my areas of professional competency. In preparation for your services, I wish to offer the following information as disclosures about my preferences and obligations as a professional counselor.

Professional and Counselor Credentials: Dr. Melissa Hager is a Licensed Professional Counselor with a Master’s and Doctoral degree from The University of Alabama. She has been counseling in the Tuscaloosa / Northport area since 1994. Her primary focus has been in marriage and family counseling as well as working extensively with teens and young adults who are transitioning to college life. In addition to her private practice, Dr. Hager is part of the adjunct faculty at the University of West Alabama teaching graduate counseling coursework.

Expectations: You can expect that I will endeavor to represent the historic Judeo-Christian faith with integrity. I will also seek to offer counseling that is both competent and compassionate. What else can you expect? Counseling is often compared to other fields with the idea that it is simply a way to "repair something that is broken." While there is some truth to this idea, counseling is not quite as precise as other fields because your needs are often not as apparent as "things that are broken." The overall purpose of our relationship will be to assist in your choices about situations you believe to be troublesome. You should expect timely replies to your requests and you should expect to understand the goals we develop for our time together. You should expect that the procedures and techniques used in our time together will be based on sound principles from my field and that they reflect the current methods of assisting persons with counseling needs. You should also know that since counseling is about trying new and different ways of behaving, thinking, and feeling, certain risks are possible for both you and those around you who may be uncomfortable with your new ways of acting, thinking, and feeling. This is common; everyone prefers to avoid changes. However, if you are determined and committed to our goals, you should expect benefits from our time together. As we progress, you should also feel free to ask for any clarification or discussion that helps you feel more comfortable with our work.

Confidentiality: As a general rule, all counseling activities, records, and identification information remains confidential. However, it is essential that you are aware that some limits to confidentiality do apply for counselors in Alabama. Based upon previous legal decisions confidentiality must be compromised in instances when clients present a potential to harm themselves or others and/or if the suspicion of harm/neglect/abuse exists for a minor. Similarly,

confidentiality may be compromised when court-ordered release of records is demanded. While these instances are quite serious, they are also infrequent.

Consultation: Consultation with colleagues is sometimes necessary to assist in your services. Such consultation is typically provided with protection of clients' identity.

Freedom to Choose/Freedom to Refer: Counseling services do feature an element of business for clients to consider. Clients are clearly free to choose to continue in services or to refuse services as they are offered. Such situations are uncommon, but you should know that your right not to participate as agreed is a right you may wish to exercise. Likewise, counselors are free to refer persons for alternate counseling services if they feel such a decision would be in their client’s best interests.

Length of Session: Typical sessions are fifty (50) minutes in length. If the client and I feel an extension beyond the typical length is necessary, such extension may be offered.

After-Hours Contact: Non-emergency, after-hours contact is typically discouraged in order to observe necessary boundaries between you and me. If such a contact is necessary, please limit your contact to 5 minutes. For emergency services, your quickest and most certain response will be through contacting the Emergency Room of DCH Regional Medical Center (759-7111).

Cancellation: This office does not practice double booking; the time assigned for your session is devoted entirely to you. As a result, it is important if you need to cancel the appointment that you notify the office 48 hours before your scheduled appointment so this time can be given to someone else. Monday appointments must be cancelled by 9 a.m. the Thursday before to avoid being charged for that session. If you cancel an appointment without the required notice or if you elect not to meet your session, the fee for your session will be charged to the credit card on file.

Important Information About Fees:

1. The charge for the first visit and intake is $100. The standard charge thereafter for a session (50 minutes) is $90. That cost may be lower if you are a member of a Partner Church.

2. A broken appointment is a loss to everyone, so if you need to cancel please inform us 48 hours before your scheduled appointment to avoid being charged for that session ($90.00). Monday’s appointment must be cancelled by 9 a.m. the Thursday before. This session charge ($90.00) will be made with my credit card on file. If I do not have a card on file, I agree to pay the balance within 10 days of notification by TCC.

____ 3. A client must have a valid credit card on file while their case is open. If the client does not have a valid credit card, the client will need to stay current with their payments.

____ 4. If a client is from a Partner Church, the fee designated by the Pastor of that church will be

due before leaving the office. If a client leaves without paying for the service, the total

amount of the service plus a $5 charge will be billed to the client’s credit card.

5. If the center bills a credit card for service and finds that the card is no longer valid, the center will contact once for a new card number. If a new card number cannot be given or the center cannot get in touch with the client for any reason, the client will be billed with a $20 fee added to the balance.

6. If a client pays with a check and the check doesn’t clear with the bank, there will be a $30.00 charge. The client will then have to pay with cash or credit card.

7. If you call during the day, I will most days have time to visit with you for 3-5 minutes.

However, there will be a charge for anything longer than 5 minutes. The charge will be

prorated on the basis of our hourly session fee and your credit card charged.

____ 8. E-mails have become an item for clarification. As a general rule, I do not respond to

e-mails. If you send me information about your case, that is welcome. It will be placed

in your file.

9. If Ms. Hager is called into court to testify for or against, she will be paid one week in

advance at the rate of $250 an hour. The time will begin from the time she leaves the

office until the time in which she returns to the office after court. The amount is payable

even if the date is changed or moved. This is due to the fact that other clients will be

inconvenienced and Ms. Hager will not have the opportunity to reschedule clients

for the day.

____10. The center does work with a few insurance companies. Otherwise, the center will provide the necessary paperwork so the client can file for insurance reimbursement. The client is responsible for co-payment the day service is provided, if they have insurance. If we provide the paperwork, the client is responsible for entire payment the day of service.

____11. If my insurance company refuses to pay the claim or has not reimbursed TCC within 60 days of the date filed, I give TCC permission to charge my credit card on file for payment. If I do not have a card on file, I agree to pay the balance within 10 days of notification by TCC.

12. If for some reason my Partner Church fails to pay their partnership fee, I understand that I

am responsible for the full amount of the session ($90.00). Or, if my church is directly

paying the bill for me and I do not call 48 hours before my scheduled appointment, I will be responsible for the full amount of the session ($90.00). The charge will be made with my credit card on file. If I do not have a card on file, I agree to pay the balance within 10 days of notification by TCC.

13. If asked to write a letter or report (for a lawyer, MD, i.e.), there will be a minimum

$100.00 charge to cover the time and expense for our office. The payment is due at the time the report is requested. Unless the client pays with cash or check, the center is

authorized to use the client’s credit card on file. If there is an unpaid balance, that must

be paid before records will be released.

Put your initials to the left of those numbers with a line; this indicates your agreement with the statement. Please verify by signature that you have read, understood, and agreed to the contents of my disclosure. Please request more discussion on any item if you feel the need for more information. By signing below, I agree to follow all of the policies of the center.

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Client/Parent/Guardian Date

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