614 Counseling Services does not offer 24 hour emergency services. If a crisis situation should arise, please call 911, go to the nearest hospital ER, or contact Netcare Access at 614-276-2273. Please also call me and leave a detailed message to make me aware of your situation; I will work diligently for your safety and wellbeing.

Unless otherwise stated, all counseling sessions are 53 minutes long. If you need to cancel or reschedule an appointment, please notify your counselor as soon as you are able, so that we can open that time up to other clients. If you must cancel at the last minute, please ensure your cancellation is made 24 hours before your appointment. If you miss a session without cancelling, or cancel with less than 24 hours notice, you will automatically be billed the rate of $100, which cannot be covered by insurance and must be paid out-of-pocket. In order to create a clear cut-off for acceptable cancellations and ensure therapeutic work is sustainable, the late cancellation fee will automatically be charged for any cancellation made less than 24 hours in advance of the appointment to the minute. If you would like to request an exception to the charges for late cancellation, please provide a written request, including an explanation and any supporting evidence you would like to include and your request be considered and a response provided in a timely manner.

In addition, you are responsible for coming to your session on time; if you are late, your session will end at the regularly scheduled end time. Your counseling will terminate when you have received what you were seeking from counseling, when you have realized the maximum benefit from the services, or when you are not likely to benefit from counseling. Termination is mutually agreed upon; however, the ultimate decision might be made independently by either the counselor or the client, depending on the circumstances.The use of drugs or alcohol before or during the counseling appointment is prohibited. If the counselor suspects any engagement, you will be sent home and billed for the entire session.

You have a right to refuse any recommended services or modality of change, including the right to terminate therapy at any time. The counselor’s job is to provide assessment and counseling and work conjointly with you to set treatment goals. It is true that counseling success depends on the client actively wanting to change. Counseling is not an exact science, and at times the counselor, in consultation with you, may need to revise the goals of treatment. Some assessment will be carried out at the time of intake, and other assessments may be added later for further clarification.

Minors (children or adolescents under the age of 18 years) and adults who have been adjudicated incompetent in a court of law do not have a legal right to enter into contracts; thus, the parents or guardian control their legal rights. At the same time, counselors have an ethical obligation to the clients themselves. Although parents and guardians have a legal right to know the contents of their children’s counseling sessions, it is imperative to understand the critical nature confidentiality plays in the effectiveness of treatment. Therefore, in order to balance the ethical rights of clients to make choices, their capacity to give consent or assent to counseling, and the rights and responsibilities of parents or families to protect minor clients and make decisions on their behalf, we will establish a thorough understanding with all parties regarding the issue of confidentiality. A verbal/written informed consent agreement among counselors, their minor clients, and those parents of minors is utilized in order to avoid misunderstandings.

614 Counseling Services is a part of an Organized Health Care Arrangement involving Seasons Counseling Services, LLC, and Ohio Health Group programs (www.ohiohealthcin.com and www.ohiohealthyplans.com) which are designed to provide effective and clinically integrated care. Specifically, Seasons Counseling Services acts as a third-party biller on behalf of my practice so the name “Seasons” may appear on your bills, claims, notices, credit card statements, etc. Privacy In connection with the above programs/organizations I may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes in most instances without your consent under HIPAA (Health Insurance Portability and AccountabilityAct) but will obtain consent in another form for disclosing PHI for other reasons, including disclosing PHI outside of this practice or the Organized Health Care Arrangement. In all instances I will only disclose the minimum necessary information in order to accomplish the intended purpose of processing claims and collecting payment.Insurance questions or issuesIf at any point you have questions about an insurance related matter – please feel free to reach out to Kimberly Burns with Seasons Counseling Services and she will be happy to assist you:Kimberly Burns 614-506-7825kim@reclaiminsurance.comBy signing this form I acknowledge the arrangement with Seasons Counseling Services and OhioHealth Group and understand that my information may be shared for insurance billing/payment collection purposes.

Please bring any complaints or concerns directly to your therapist. Part of the therapeutic process is working through these types of concerns with your therapist. If you have concerns about your fit with your counselor, bring those up with them and they will address them or help you to seek alternative care options. If the complaint is not handled to your satisfaction, you can then also make a complaint with Andy Erkis at andy@stratasconsultinggroup.com or with the Counselor, Social Worker, and Marriage and Family Therapist Board. They can be contacted at cswmft.info@cswb.state.oh.us or 614-728-7791 (this number is for complaints only). More information about the Board can be found online at http://www.cswmft.ohio.gov/.