Effective date: 17 January 2022
Individual appointments are scheduled for 50-minute segments unless you schedule an extended session. Initial appointments are scheduled for 60 minutes. Couples appointments can be scheduled for60 minutes or 75 minutes segments. At the end of each session we will make sure to have the following session scheduled.
Please remember to cancel or reschedule 24 hours in advance. You will be responsible for the entire fee if cancellation is less than 24 hours. Again, cancellations and re-scheduled sessions will be subject to a full charge if NOT RECEIVED AT LEAST 24 HOURS IN ADVANCE. This is necessary because a time commitment is made to you and is held exclusively for you. Additionally, I typically have a waitlist for my services; canceling with enough advanced notice allows individuals who are in need to receive services. If you are late for a session, you may lose some of that session time. If I am late to a session, you are guaranteed your entire session time.
If I do not hear from you after a missed appointment and have reason for concern, I may reach out to your identified emergency contact to ensure your well-being. Please note that multiple missed/canceled appointments and late arrivals may require us to discontinue treatment. In this circumstance, I will discuss with you by phone how we should proceed.
EMERGENCY AND CRISIS SUPPORT
I do not provide 24-hour crisis services. If a life-threatening crisis should occur, contact a crisis hotline(24-hour Helpline, 713-970-7000), call 911, or go to a hospital emergency room. As an individual provider who is not in a group practice, I am generally in a therapy session during working hours and am unavailable outside of working hours. If it is likely that you may need crisis support, let’s discuss this so that I can be sure you have the level of care you need. You deserve support that matches your needs.
If you need to contact me between sessions, please send me a text message or leave a message on my voicemail. I am often not immediately available; however, I will attempt to return your message within 24 hours.
SOCIAL MEDIA AND TELECOMMUNICATION
Due to the importance of your confidentiality and the importance of minimizing dual relationships, I do not accept friend or contact requests from current or former clients on any social networking site(LinkedIn, etc). I believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. If you have questions about this, please bring them up when we meet and we can talk more about it.
I cannot ensure the confidentiality of any form of communication through electronic media, such as email and text.
When you send an email it has the potential to be seen by many people prior to reaching its destination. For this reason, I will prefer not to discuss anything clinical with you via email and I ask you to refrain from doing so, as well. However, if you prefer to communicate via email or text messaging for issues regarding scheduling or cancellations, I will do so.
Text messaging and email will primarily be used for administrative tasks only. I may not acknowledge or return emails or text messages that are not administrative. While I may try to return messages in a timely manner, I cannot guarantee immediate response and request that you do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies.
By signing this consent, you authorize Jenet Dove Counseling, Services, PLLC. to communicate and provide various assessment tools used in the counseling process to the un-encrypted personal email address you provided to Jenet Dove Counseling Services, PLLC.
I am required by law to maintain records of each time we meet or talk on the phone. These records include a brief synopsis of the conversation along with any observations or plans for the next meeting. If records are requested for any purpose, my policy is to provide an appropriate summary, as records can be misinterpreted.
I do not accept insurance. I am considered out of network for all insurance policies. Clients who carry insurance should remember that professional services are rendered and charged to the clients and not to the insurance companies. If requested, I will provide you with a copy of your statement via email, which you can then submit to your insurance company for reimbursement. You must be aware that not all issues/problems dealt with in therapy are reimbursed by insurance companies and filing may require the release of confidential information such as mental health diagnosis, which could be utilized in future insurance decisions. It is your responsibility to verify the specifics of your coverage.
Due to the nature of the therapeutic process and the fact that it often involves making a full disclosure with regard to the many matters which may be of a confidential nature, it is agreed that should there be legal proceedings (such as, but not limited to, divorce and custody disputes, injuries, lawsuits, etc.…), neither you (client) nor your attorney’s, nor anyone else acting on your behalf will call on me to testify in court or at any other proceeding, nor will a disclosure of the psychotherapy records be requested unless otherwise agreed upon. If you do become involved in litigation requiring your my participation, you will be expected to pay for the professional time even if I’m compelled to testify by another party.
Please be advised that should I be requested to write a letter on any court-related matter, I will NOT be stipulating in writing or in person as to an opinion. As your therapist, I may only provide observations and feedback. At no time will I make a recommendation in regards to custody or any other court-related matter.
If a court order is served and is requesting that I be present in person and/or there is a request for records, I will request your consent before turning over confidential information. I will discuss with you exactly what has been requested by the court and there is no guarantee that the information will be kept confidential. This information includes mental health history, current status and inclusive records and may not be in your best interest. The therapist-client relationship does not render me as your advocate. I will withhold any opportunity to engage in a dual relationship in this way.
By signing this consent form, you understand and agree to the following:
Distance counseling relies on technology that may involve a shutdown or disconnect in the middle of a session. I cannot be held responsible for unforeseen problems that occur due to technical difficulties. Should a disconnect occur, I will attempt to establish a reconnect by either phone or computer as soon as possible.
You understand that online and telephone counseling is not appropriate if you experiencing a crisis or having suicidal or homicidal thoughts.
To have a release of information for an emergency contact for the location from which you will be calling.
To be domiciled (primary residence) in the state of Texas or be located on a US military base if outside of Texas.
Please specify your preference of phone (and provide your preferred number) or video when scheduling. All confidentiality during phone or videoconferencing is subject to the rules and limitations within the product used. You understand that communicating via technology, confidentiality cannot always be guaranteed.
Ending relationships can be difficult. Therefore, it is important to have a termination process in order to achieve some closure. The appropriate length of the termination depends on the length and intensity of the treatment. I may terminate treatment if I determine that the psychotherapy is not being effectively used or if you are in default on payment. I will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. If therapy is terminated for any reason or you request another therapist, I will provide you with a list of qualified psychotherapists to treat you. You may also choose someone on your own or from another referral source.
Should you fail to schedule an appointment for three consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, I must consider the professional relationship discontinued.
Jenet Dove, LPC; License # 79131
CONCERNS AND COMPLAINTS
You have the right to receive ethically sound and professional services from your therapist. It is my duty to provide services in a professional and ethical manner within accepted legal standards. If you are ever dissatisfied with my therapy services, please directly discuss these concerns with me first. If I am notable to resolve these issues, you may report complaints to the Texas State Board of Examiners Professional Counselors at:
333 Guadalupe St, Tower 3, Room 900
Austin, Texas 78701
Investigations/Complaints 24-hour, toll-free system (800) 821-3205
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