Aimee Morris Counseling, PC



Aimee Morris Counseling, P.C.Aimee Morris, LPC, LMFT7524 South Broadway, Suite 111Tyler, Texas 75703(903) 939-2287(903) 939-2938 faxAwmcounseling@The purpose of therapy and/or counseling is to help you more fully understand yourself and your situation around you. One can benefit from therapy if they choose to do so; however, it will take effort upon the client as well as the therapist to make it happen. In addition, therapy can provide a greater sense of personal growth and the ability to relate more effectively with others. There are potential risks involved in the use of these services as well as benefits. For example, in therapy, you may recall unpleasant experiences and/or uncomfortable emotions. Some people feel worse before they start to feel better. It is possible that changes made in therapy may affect your significant relationships. I may find it necessary to take complete background history which includes, but not limited to, family-of-origin, personal development, medical, religious, marital, sexual, and legal history to determine the best possible care. While it is my responsibility to provide professional, competent, and ethical services, I cannot promise or guarantee any specific outcome from these services. However, I will work in cooperation with you to help you reach your personal therapy goals.The process of therapy requires a commitment of time and energy from both you and me, the therapist. My goal is to form a healthy therapeutic relationship to give you the best possible care. To accomplish this, we must have a positive working relationship. If this does not happen, I encourage you to discuss your concerns with me so that any problems can be resolved. You have the right to decide at any time not to receive my services and to end your involvement in therapy. There is no obligation other than to pay for services that have already been rendered. If you do decide to terminate therapy before mutually agreed upon time, I encourage you to discuss this decision with me so I can provide you names of other qualified mental health professionals, if you so desire.The Therapist/Client relationship can only be therapeutic and professional. Therapists cannot engage in social activities with clients nor can they be involved in any kind of business relationship with clients. Therapists are not allowed to receive gifts over $50.00I will be able to answer telephone calls during my business hours (8:00-4:00pm Monday-Friday, except Wednesday). I encourage all clients to call with any questions and/or concerns. I do not have office staff, so if I am unable to answer the telephone, I do have a confidential answering machine that I check frequently. Please leave a message and I will return your phone call as soon as I am able. Please be aware that this is not an emergency service. If you have a crisis or emergency and cannot wait for my return call or during the evening or weekend you agree to consult with one of the following: 911Nearest Emergency RoomI choose not to accept new clients with ongoing or near future court involvement. This also includes other forensic services such as: legal depositions, courtroom testimony, child custody evaluations, home studies, or giving any recommendations, opinions, reports, or assessments to determine parental visitation or custody. I will, however, provide you with referrals. By your signature below, you are indicating that you have been advised of my policy regarding forensic services and you agree by the policy.CONFIDENTIALITYAll information that you share during therapy will be kept confidential and will not be released to anyone without your permission and written consent. To insure this, there will be no video and/or tape recording of any kind during therapy from the client(s) or therapist. However, there are certain circumstances in which I may be required to break confidentiality. These include: A situation in which you are likely a danger to yourself or another personTexas law requires that we notify the Department of Protective and Regulatory Service if we suspect that child abuse or neglect may be presentSuspected elder abuse and/or neglectIn response to legitimate court order, orWhen mental health treatment is ordered by or is under supervision of the courts.In addition, many insurance companies or managed health care organizations require the release of records and/or information for them to pay for services rendered. Your signature below authorizes me, the therapist and/or my billing company, to release information requested to your insurance company or its representative. To protect your confidentiality, my policy is to release the minimal amount of information necessary to satisfy their request. However, I have no control over how the information released is utilized by the insurance company or its representative. If applicable, records for couples/marital therapy will not be released without the permission and written consent of both parties.FINANCIAL CONSIDERATIONSI recognize the need for a clear understanding between you and me regarding financial arrangements. A copy of counseling fees can be given to you upon request. Payment is expected when services are rendered, and specific fees can be discussed if necessary. For your convenience, I prefer cash, and accept personal check, Visa, MasterCard, Discover, and American Express. I will, with your permission, send you a confirmation text for the FIRST appointment to give instructions. However, I do not send out texts to remind you of future appointments, so it is your responsibility to remember your own appointments.When you have an appointment, that time is allotted for you. Therefore, you will be charged $ 60.00 in the event you fail to give a 24-hour notice prior to canceling an appointment or for a missed appointment with no notification (no-show). Insurance companies and/or EAP’s do NOT pay for these, therefore, any missed appointments will be your financial responsibility. There is a $30.00 charge for any checks returned due to insufficient funds. There will be a $50.00/hour charge for any report/letter (review/research included) that is requested by you, attorney, and/or agency, etc. You will be responsible for fees incurred if I attend court on your behalf of $100.00/hour. You will also be responsible to pay for any and all attorney fees that I may need. If another party is court-ordered to pay for your mental health services, you must pay for your charges at the time of service and seek reimbursement from the responsible party.I will verify insurance benefits/eligibility and either I or my billing company, Healthcare Billing Specialists, will file the insurance claims for you. You will be responsible for the policy’s deductibles, co-payments, and balance after insurance payments are made or if claims are denied. In addition, you should be aware of your policy’s specific mental health benefits. If you choose to file your own insurance claim, full payment for professional services is expected at the time services are rendered.Self-paying clients need to understand that full payment is due at the time of service. Payment plans may be arranged if necessary, although all account balances shall be paid in full within 3 months.I want to resolve with you any financial difficulties which may arise regarding services rendered. However, if it is necessary, I reserve the right to use a collection agency or the courts for nonpayment of your bill. If I do send your unpaid bill to the collection agency, I will add on the agency’s collection percentage onto your bill. The dates of services and necessary information will not be considered confidential if such means must be pursued.If you have any questions and/or concerns regarding my policies and procedures, please do not hesitate to discuss them with me, your therapist. If you would like a copy for your personal records, please let me know and I will make a copy for you.I HAVE READ AND UNDERSTAND THE ABOVE POLICIES AND PROCEDURES AND I AGREE TO ABIDE BY THEM.Client Signature:_____________________________________________________ Date:_________________________Therapist Signature:__________________________________________________ Date:_________________________Parent/Guardian Signature (if applicable)___________________________________________ Date:__________________If you have a complaint, please call the telephone numbers below:Texas State Board of Licensed Professional Counselors: (512) 834-6658Texas State Board of Licensed Marriage & Family Therapists: (512) 834-6657 ................
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