Policy Consent to Treat I welcome you to my practice and hope that your visit will be worthwhile. Your goals are more likely to be met when you understand the nature and limitations of counseling. Generally, therapy/psychotropic medication is most useful in helping individuals help themselves or improve their relationships by changing feelings, thoughts, and/or behaviors. Please initial each paragraph, indicating that you have read and understood the content of that paragraph. Benefits and Risks: Most people experience improvement or resolution to the concerns that brought them to therapy, but of course, there are no guarantees, and there are some risks. For example, therapy could open up new levels of awareness that may cause discomfort. Confidentiality of Cell Phones, Email and Fax Communication: It is important to be aware that every effort will be made to maintain confidentiality when using these types of communication. It is noted that all texts, voice messages, emails or faxes can erroneously be sent to a wrong address. I will make every effort to avoid these types of situations happening. If it does happen and is brought to my awareness, I will contact you immediately. Texting to my cell phone if you must clarify anything is acceptable. Consultation: As your provider, I may consult with other professionals regarding a case. It is noted, however, that your name and any other identifying information will not be mentioned. Your identity will remain anonymous, and confidentiality will be maintained. Written consent will be obtained from you prior to any consultation taking place with another professional where your identity will be revealed. An example of this would be if you are also working with another professional, such as a psychiatrist, and case staffing is needed to coordinate treatment. Discussion of Treatment Plan: Within a reasonable period of time after the initial assessment, I will discuss with you my working understanding of your presenting issues, the treatment plan, and therapeutic objectives. If you have any unanswered questions about the course of your treatment, the possible risks, please ask and your questions will be answered fully. You have the right to ask about treatment and risks and benefits of the treatment plan. Consent to Treatment: Seeking psychiatric assistance and care can result in several benefits to you, including improving interpersonal relationships and resolution of the specific concerns that led you to seek treatment. Mental health treatment requires your active involvement, honesty, and openness in expressing self. Remembering and talking about painful memories and unpleasant events, feelings, or thoughts can result in experiencing considerable discomfort or strong feelings. I may challenge some of your assumptions or perceptions, which may cause you to feel upset, angry, sad or disappointed. Attempting to resolve issues that brought you to therapy, such as personal or interpersonal relationships, may result in changes that were not originally intended. Sometimes a decision that is positive for one family member is viewed quite differently by another family member. Change will at times be easy and swift but at other times it is slow and even frustrating. During treatment, I am likely to draw on various therapeutic approaches to best benefit you. Payment of Fees: If you are uninsured: $150 fee for the first visit/evaluation $75 for each ½ hour visit for medication management Payment can be made by Zelle, Cash, or CashApp prior to the session by using my cell number,firstname.lastname@example.org. unless a different fee was agreed upon. You will not receive an invoice and your receipt will be issued via your payment mode. If you are insured: Blue Cross Blue Shield, Medicare, Medicaid, Cigna, Evolutions, etc Cancellation of appointment: They can be made any time before the appointment by text or phone call. No fee will be charged if I receive a notice. Termination: You have the right to terminate consultation/services at any time. If at any point during your treatment, If you believe I am not effective in helping you reach your therapeutic goals, I obliged to discuss it with you and if appropriate, terminate treatment and give you possible referrals. You are encouraged to terminate treatment within a session so that you will have satisfactory closure. Text message terminations will not be acknowledged. CONSENT TO TREAT WITH PSYCHOTROPIC MEDICATIONS I consent to be assessed and treated for psychiatric symptoms by Bridgette Reid Psychiatric Mental Health NP-BC. I understand that I will receive scheduled appointments for follow up to monitor the effectiveness of the medications. Failure to keep appointments without communication will result in a discontinuation of the medication. If I choose to see another prescriber I will be prescribed a sufficient amount of medication to allow for one month to obtain an appointment. I understand that I am responsible for contacting this prescriber to inform her of any questions or problems which might arise with the effects of the medications and can expect a rapid response by texting 863 866 0306. There will be a discussion about my medications before they are prescribed so that I have the choice to refuse. Please type your name below as acknowledgement and consent to the above. Refills: I understand that Beyond Psychiatry LLC will not call in refills for me if I run out of medication sooner than the indicated date on the prescription. I understand that Beyond Psychiatry LLC may not change medications on me unless they do a tele psych encounter with me. I understand that the employees of Beyond Psychiatry LLC are required to report any threats of harm to self or others, as well as any criminal activity that is divulged to any staff at any time. I understand that I am responsible for contacting this prescriber to inform her of any questions or problems which might arise with the effects of the medications and can expect a rapid response by texting 863 866 0306. There will be a discussion about my medications before they are prescribed so that I have the choice to refuse. Please type your name below as acknowledgement and consent to the above.