Steven Monroe, LMFT #92746

                                   Individual, Couples, Child, and Family Therapy

                                                                  323-327-2399               

                                   

Welcome! This document is to acquaint you with the procedures and processes of therapy. I am a Licensed Marriage and Family Therapist (Lic. #92746). Please carefully read the office policies below:

                                                                  Appointments

1. Your appointment time will be weekly. Sessions last 50 minutes.

2. Your appointment is your time for therapy. Should you cancel or postpone without a minimum of 24-hour notice, you will be charged your usual fee. The fee for cancelled appointments is payable at the beginning of your next scheduled appointment.

3. Therapy may be terminated after two consecutive cancellations.

4. Should you require additional sessions, please ask and I will do my best to schedule the time for you.

5. Often clients wait until the end of their sessions to bring up troubling problems. I encourage you to bring these problems up at the beginning of the hour in order to have time to discuss them. 

                                                                         Fees

My fee is $140, and the session is 50 minutes long.  I accept cash, check, credit, and, in some cases, can process payment through PPO insurance as an out-of-network provider. You are expected to submit your payment/check at the beginning of the session, to ensure that the entire session is dedicated to your therapeutic work.  If there is an unpaid balance due to your bank, or any returned check, you are expected to clear this up prior to your next week’s appointment, unless otherwise arranged. There is a process fee of $25 for any returned checks. Payment is due at the beginning of each session, in addition to confirmation of your next week’s appointment, in order to ensure that the full 50 minutes is devoted to therapy.

                                                         Telephone Communication

You may leave a message anytime at my office # (323) 327-2399. I will return your call as soon as possible.

       1. In an emergency leave a message on my office phone. We may discuss what constitutes an emergency.

       2. I check my voicemail frequently,  Monday through Saturday, and will return your call at my first available opportunity. If there is an emergency on Sunday, please call your hospital emergency room.

       3. Under certain conditions, a phone session may be arranged for your usual fee.

       4. There is no charge for calls less than five minutes. For calls over five minutes there will be a charge for ½ session or a full session over 30 minutes.

                                                                  Emergencies

I return phone calls from 8am to 10pm, Monday through Saturday, unless I am away on vacation or family emergency. If you have an emergency, please contact your local hospital or call 911, as I carry my phone only during the times listed above.

                                                                  Confidentiality

    1. The information disclosed in a session is confidential, except when related to sexual or physical abuse to a minor, elder, or dependent adult or when there is danger to self or others.

   2. Confidential information will only be released to other professionals if you sign a “Release of Confidential Information”  form.

   3. Any relevant information discussed with family members seen individually will be integrated into conjoint session with my support.

   4. In child or adolescent therapy, I will share general information, but not private details with parents unless a breach of confidentiality is indicated for legal reasons.

                                                                 Termination

Our office has an ethical responsibility to continue our therapeutic relationship as long as it is reasonably clear that you are benefiting from the relationship. We will need to discuss termination if you are unwilling to comply with our therapeutic recommendations or if you do not maintain your agreed financial payment. We request that if you decide to terminate, you DO SO IN PERSON – NOT ON THE PHONE. This allows for a final session or sessions to be scheduled to explore the reasons for termination, and to review the treatment that has occurred. Termination itself can be a constructive, useful process. If a referral is warranted, it will be provided during the final session. 

 

I acknowledge the above contract and agree with all of the terms and conditions set forth in the above therapeutic contract.

 

_______________________________________________________________

    Client’s Name                                     Client Signature                               Date

     (please print)