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Terms and Policy

‌DISCLOSURE STATEMENT -IMPORTANT INFORMATION.

DISCLOSURE STATEMENT -IMPORTANT INFORMATION.

KNOW YOUR RIGHTS, and OUR RATES, FEES & POLICIES
Sunrise Couples & Family Therapy

850 39th Ave SW, Suites A211-12

Puyallup, WA 98373

o: (253) 777-9782


INFORMED CONSENT
In accordance with the Washington Administrative Code and the revised Code of Washington, the following Client Disclosure Information is provided for the client and must be signed by both the client(s) and counselor. The client's signature indicates that she/he has read and understands the information.

This document contains important information about my professional services and business policies. It also contains information about my policies and practices to protect the privacy of your health information including the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and patient rights about use and disclosure of your Protected Health Information (PHI) for treatment, payment and health care operations. Please read it carefully and discuss any questions you may have with me.

When you sign this document, you will be stating that your therapist provided you with this information and it will represent an agreement between us. With your permission and when therapeutically appropriate I use audio and/or video recording in our sessions to improve my work as a therapist. I review recordings myself and very occasionally share a partial transcript (with all identifying information removed) in supervision about a case. I keep only 1-2 session recordings at a time all are kept in a password protected folder on my password protected computer. For Firefighters, Law Enforcement Officers and others in sensitive professionals. No recording will take place.

CLIENTS RIGHTS

Therapy is a relationship between people that works in part because of clearly defined rights and responsibilities held by each person. As a client you enjoy certain rights that are important to fully understand:
1.) You are entitled to receive information from me about my methods of therapy, the techniques I use, and the duration of therapy, and my fee structure. Please ask if you have any questions.
2.) You can seek a second opinion from another therapist or terminate therapy at any time.
3.) You have the right to a referral if you want a different therapist and one is available.
4.) You have the right to request restrictions on certain uses and disclosure of protected health information about you.
5.) You have the right to release confidential information about yourself. This requires your written consent.
6.) You have the right to rescind your release of information, in writing. However, if disclosure have been previously made based upon earlier consent, these disclosures cannot be undone.
7.) You have the right to receive an accounting of disclosures of Protected Health Information (PHI).
8.) You have the right to receive confidential communication in a manner that is appropriate for you, whether an alternative location or phone; providing accommodation can be made.
9.) You have the right to inspect and obtain a copy of your file. You must make request in writing. This does not include information gathered in anticipation of, or for use in civil/criminal, or administrative action; information that I cannot legally disclose to you; or information that I determine should not be disclosed to you because it might hurt you or someone else.
10.) You have the right to obtain a copy of this notice.

As your therapist I'm required by law to do the following:
- To maintain the privacy of protected health information. "Health information" refers to your name, address, security number, insurance information, and other identifiable data.
- To provide you this notice of my legal duties and privacy practices regarding health information about you.
- To follow the terms of my notice that is currently in effect.

COMPLAINTS
There is an established procedure in the State of Washington for filing complaints about mental health professionals. Unprofessional conduct is defined under the Revised Code of Washington (RCW 18.130.180). If you feel you have been treated unethically or unprofessionally you may send a written complaint to the Washington State Department of Health, PO Box 47869, Olympia, WA. 98504

CREDENTIALS
"My name is Miles Hall, and I'm a Licensed Marriage & Family Therapist Associate (LMFTA), and Mental Health Professional (MHP). I'm supervised, licensed & insured in the State of Washington. I received my undergraduate degree(s) with honors from Washington State University in Psychology, Political Science & Sociology in 2010. I graduated in 2016, from Pacific Lutheran University with my Master's degree in Marriage & Family Therapy. I plan to begin doctoral studies in 2020. Additionally, Im trained in Clinical Heart-Centered Hypnotherapy (CHt).

COUNSELING APPROACH

Systems theory is an interdisciplinary theory which studies the intrinsic nature of complex systems in nature, society, and science, and is the framework by which I listen, assess, then advise. This theory and my services can be applied to any Individual. Couple, Family or Organization. I endeavor to foster a supportive environment which understands that families and those in relationships sometimes get into difficulties due to   their differences or feel the strain when loved ones have troubles.

I use a combination of theories; primary solution-focused, experiential, and cognitive behavioral therapies. The aim of therapy is to work on these problems by encouraging individuals, family members and loved ones to help and empathize with each other. Counseling may involve helping you identify, develop, and implement more effective strategies for problem solving and how to make healthier decisions. At times I may ask you to do some specific activities outside our sessions, such as keeping a journal or reading a book that I think would be helpful. The length of time you would be in treatment cannot be known early-on. Counseling is understood to be a choice you've made among available options. Other options include: Receiving therapy from another counselor, using other therapies, using support groups, seeking self-help resources, and other modes of treatment.

Therapy can have benefits and risks. The risks may include experiencing uncomfortable feelings like sadness, guilt, anger, anxiety or frustration when discussing aspects of your life. Therapy has been shown to have benefits that can include better relationships, solutions to specific problems, increased life satisfaction, improved physical health, and significant reductions in feelings of distress. However, there are no guarantees of what you will experience. For therapy to have the best outcome you will have to invest energy in the process and work actively on things we talk about both during and between our sessions. Of course, you retain the right to discontinue treatment at any time you believe the risks begin to out-weight the benefits.

CONFIDENTIALITY
The law protects the privacy of all communication between a client and licensed therapist. I receive ongoing supervision of my work. Your confidential information may be shared with my supervisor in order to ensure high quality therapeutic care. The law provides the following additional exceptions to confidentiality:
- To advert serious threat to your health/safety or that of another person.
- I'm a mandated reporter for child abuse/neglect or adult abuse/neglect.
- Information concerning the contemplation of or commission of a crime or harmful act is not considered confidential information.
- If records are subpoenaed by the Washington State Department of Health.
- Court Ordered Records release: if records are requested by the courts. I will make reasonable efforts to notify you or your legal representative.
- I will not release confidential information without a signed written release from you, a subpoena, and court order or otherwise requires by law.
- To provide you medical treatment or for workers' compensation.
- To bill and collect payment from you. This includes sharing information with your health provider.

RECORDS
According to Washington State law (RCW 246.809.035), I'm required to keep complete records for all the therapeutic services I provide. Your records are maintained in a secure manner. I keep brief records and notations of your name, fees paid, dates/times of sessions, this consent, presenting problem, treatment goals, and notes from any formal consultation with my supervisor.

NO SECRETS POLICY
The relationship between a therapist and a client is fundamentally based upon trust. When working with couples or families it is vital that every person in the therapy room be able to trust me to be fully honest with them. For this reason, I will not keep secrets shared during individual sessions which I believe to be therapeutically important. I will work with the individual to assist them in revealing the information themselves; but if after reasonable time the individual will not share the secret, I will have to terminate therapy and refer them to another therapist.

PARENTS & MINORS
While privacy in therapy is crucial to successful progress, parental involvement can also be essential. It is my policy not to provide treatment to a child under age 13 unless s/he agrees that I can share whatever information I consider necessary with a parent. For children 14 and older, I request an agreement between the client and parents be completed allowing me to share general information about treatment progress and attendance, including a treatment summary when therapy is terminated. All other communication will require the child's agreement, unless I feel there is a safety concerns (see Confidentiality section), in which case I will make every effort to notify the child of my intention to disclose information ahead of time.


SESSIONS INFO | FEES & BILLING | 48 hr. CANCELLATION POLICY-THIS IS VERY IMPORTANT
Therapy can involve a significant investment of time, energy and money, so it is important that we take time to assess and determine if I'm the therapist you are comfortable working with. If at any time you have questions about any aspect of our work together, please discuss it with me. If you decide that you do not want to continue in therapy with me, just let me know if you want help finding another therapist or other appropriate resources.

Initial session is scheduled for 75-minutes, about 70-minutes (face to face time) to assess presenting concerns and develop treatment plan with follow-up session about 53 minutes long. If you arrive late for an appointment, if possible, based upon the days schedule, you will only be able to meet with me for the remaining time of the scheduled session. The time set aside for your appointment is time reserved for you. Sessions end on time, even if we are in the middle of something. If session continue passed scheduled time. Additional fees apply and are billed based upon established fee schedule for 53 min, 75 min or 90 min session times.

Our first few sessions will involve my answering any questions, establishing expectations, gaining clarity around the Informed Consent documentation, evaluation of your situation and needs then we will discuss goals based upon what you want to work towards. I will offer you some information so that you will have an idea of what our work together will be like. During this time, we can both decide if I am the best person to provide the services you need.


Credit cards may be charged for session fees up to 24 hours prior or after your scheduled appointment. Additional fees may apply for other services including telephone calls, consults, requested reports, letters and consultations with other professionals. These fees will be charged at (15 min) intervals. We use timecards/sheets and timers to ensure accurate reporting, and for session timekeeping.

A valid debit, health savings, or credit card is required to book a session. You will be expected to pay the full fee. All session invoices not paid   due to declined or invalid credit card will be subject to a $10 charge.


All invoices not paid 24 hours after session completion are subject to an additional $25 fee, and subject to referral for collection (unless prior arrangements have been made).

We currently are not a direct insurance provider. Payment is due at the beginning of session unless we agree otherwise. We accept payments by debit or credit cards. Payment schedules for other professional services will be agreed to when they are requested. Please carefully review our client fees acknowledgement for details about specific cost for each type of service. We are a private pay practice considered an out-of-network provider. Sunrise Couples Therapy will provide the necessary paperwork for you to submit directly to your insurance company for reimbursement.


By having you submit for reimbursement it allows us to protect your confidentiality and privacy. We are not required to disclosure any information to insurance companies, or third party payers about the nature of your care, diagnosis, treatment plan or attendance at therapy sessions.

Late, canceled or rescheduled sessions are charged as No Call No Show (NCNS) at full fee after 20 mins late, or if you do not show up, cancel, reschedule or cannot come for your scheduled appointment. You can avoid paying a cancellation/NCNS fee (the full cost of the session), by notifying us directly at least 48 hours prior to your scheduled appointment time via telephone, email, messaging or by using your secure client portal. 

All session scheduled for the same day or less than 48 hours from the time of service will be charged at the time of scheduling. If the session is missed or cancelled the full cancellation fee will be charged. 48-hour cancellation policy is enforced.


LEGAL CONSULTATIONS:

I will provide documentation of your participation in therapy upon request but will not participate in court proceedings or make recommendations for the court. If your case is currently court-involved or court-ordered, I require that you sign releases to for me to speak to the referring party. If you become involved in legal proceedings that require my participation, you will be expected to pay for your therapist's professional time even if I'm called to testify by another party. 

The rate for legal depositions, requested by either the client or client's attorney, is $600.00 per hour max. of 4 hours. The rate for a requested court appearance, with or without counselor testimony, is $2500.00 per day. All requested deposition and court appearance fees must be paid in full 30 days prior to the scheduled deposition or trial, unless other arrangements have been made in writing. The party requesting the deposition or court appearance is responsible for payment.

ELECTRONIC COMMUNICATIONS
Traditional email and text messaging is not held to HIPAA compliance standards. As a result, your confidentiality can not be honored in the same way as by phone or in person. With this in mind, many clients rely on text and email for convenient communication. Please use these at your own discretion. We understand and accept your initiation of this kind of electronic communication as consent to respond by the same means. We hold client confidentiality as a foremost responsibility and suggest that clients use our secure portal to communicate with us.

TELETHERAPY & CRISIS
Online counseling is not appropriate for all kinds of problems. If you have suicidal thoughts, it's important that you seek help immediately. If you are located in the US, call 1.800.784.2433 or 911 and ask for help. If you are in a life-threatening situation or crisis, DO NOT use this service. Please contact your local crisis line.

AVAILABILITY AND CRISIS
If you need to contact us outside scheduled therapy time, we can be reached at (253) 777-9782. If we are unavailable to answer your call, please leave a message to include a return telephone number and the best time to be reached. If you have an urgent need, please indicate this in the message. We do our best to return all call within 48 hours. However, if you call in the evening (after 5pm) or on the weekend, we may not receive your message until the next business day, excluding holidays.

Should you need emergency assistance before we can return your call, you still have several options: (1) Call a friend or another member of your support network (2) Call your local crisis hotline a. (800) 576-7764 in Pierce County b. (800) 244-5767 in King County c. (800) 627-2211 in Thurston County (3) In the event of a medical emergency or an emergency involving a threat to your safety or the safety of others, please call 911 to request emergency assistance.

ACKNOWLEDGMENT AND AGREEMENT
By signing below, each of us confirms this disclosure document to represent the agreement between us, and you confirm receiving and reading a copy, and you confirm your understanding of the information provided and agree to allow the disclosures of health information as described above.

( Type Full Name )