RAINIER ASSOCIATES
5909 Orchard West
Tacoma, Washington 98467
253-475-6021 * 253-474-1871(FAX)
www.rainierassociates.com
J. Dale Howard, M.D. Clinical Associates
Barry S. Anton, Ph.D., ABPP Emily Schoenfelder, M.S.W. George Jackson, M.D.
Naomi Huddlestone, Ph.D. Catherine A.J. Mulhall
Fletcher B. Taylor, M.D. Vanessa Honn, Ph.D.
Trenton J. Williams, Ph.D. Ryan Coon, Psy.D.
Susan J. Poole, Ph.D. Jodi Howell, Ph.D.
Nagavedu Raghunath, M.D. Amy Dwyer, M.S.W.
E. Thomas Dowd, PhD.,ABPP
Naomi Huddlestone, Ph.D.
APPOINTMENTS: Individual appointments are usually 60 minutes in length. Your appointment begins at our agreed upon time. It is important to be on time because your appointment cannot be extended beyond the scheduled time since other people may have reserved that time. Your appointment time is held exclusively for you. If you are unable to keep your appointment for any reason, you must give at least 24 hours advance notice to cancel; otherwise you will be charged $50.00 for the time reserved for you. This office does not give reminder calls for appointments. It is your responsibility to remember and keep track of your appointments. Parents of minor children must remain on the premises during the child’s appointment.
GUARANTEES AND PROMISES: When you request treatment or an evaluation for yourself or for a person for whom you are responsible, I shall do my best to perform all services in a professionally competent manner. Licensing as a Psychologist in the State of Washington entails extensive training after the Ph.D. has been obtained, including written and oral examinations covering the field of psychology, and requirements for continuing education to maintain skills and current knowledge in the field. My training at the University of Michigan (Ph.D. in Clinical Psychology), and at Children's Psychiatric Hospital, and The Adolescent Service of the Neuropsychiatric Institute in Ann Arbor, stressed meeting the patients' needs in the selection and utilization of the therapeutic approach. I will try to explain to you the kinds of treatments that are typically used, approaches to assessment, length and course of treatment for the issues that you describe, and other options that may be available to you in treating the kinds of issues or problems discussed. In this regard, I encourage you to raise questions about the nature and course of treatment. You have a right to request a change of therapy, referral to another therapist, or to discontinue therapy. There are no guarantees that the results of any evaluation or therapy will conform to your expectations. I make no promise to determine any particular diagnosis or to reach any particular outcome from treatment. Effective treatment and accurate assessment depend to a significant degree on your openness and your commitment to change. Much of the responsibility for a successful outcome is yours.
ETHICS AND PROFESSIONAL STANDARDS: As a Licensed Clinical Psychologist, a member of the American Psychological Association, and the Washington State Psychological Association, and as a graduate of an APA accredited doctoral program in Clinical Psychology, I work to uphold the highest standards of my profession. I invite your questions concerning ethical or other professional matters at any time. The Board of Psychology Examiners in Olympia (360-753-3095) and the Washington State Psychological Association (206-547-4220) are also available to respond to your questions and concerns.
PRIVACY ISSUES: In conducting therapy with children, it is difficult to draw the line between the child's need to have his communications to the therapist remain confidential, and the parents' right to know what is happening with their child. The contract I set up with my child patients and their families involves an agreement that what the child tells me does not routinely get reported to the parents; if I feel that it is important for the parents to know about something the child has revealed I will first discuss with the child his parents' need to know about a particular issue. Whenever possible, I prefer to discuss these issues during a joint session with both parents and the child present. I encourage the parents of my child patients to maintain frequent contacts with me to keep me informed of current events in the family. The more information I have, the more effectively I can do my job.
Please see the attached “Confidentiality & Medical Records” document for additional details regarding the privacy of your health information.
EMERGENCY CALLS: An Answering Service takes all emergency calls outside of regular business hours. This service will attempt to locate me in the event of an emergency. If I am not available, another member of our group can be reached through the answering service.
Fees for reports, letters, review of materials, and phone calls may be charged on a pro-rated basis according to time actually required.
BILLING AND PAYMENTS: Patients or their responsible legal guardian are responsible for their accounts and are expected to pay their bills when due, whether medical insurance pays for a portion or not. This includes charges for evaluation, printed materials, reports, letters, consultations and telephone calls. Co-pays are due at the time of your appointment. When 90 days have passed without a payment or prior arrangement with me, accounts may be sent to an agency for collection and the patient or legal guardian may be responsible for any additional legal and/or collection agency charges. Results of evaluations or reports may not be released until accounts are paid in full.
It is recommended that you pay at the time of each visit the portion of your bill which your primary insurance will not cover. Balances which patients allow to accumulate can begin to look very intimidating and may, in fact, interfere with the therapeutic process. We understand that this is an expensive treatment and we are prepared to arrange an extended payment plan. This entails a written agreement to pay a fixed amount regularly each month until the balance is paid. If regular payments stop, the balance will be considered delinquent, and the finance charges and collection procedures detailed above may be instituted.
Bills are sent out monthly and detail the dates of visits, the type of service provided, whether your insurance company has been billed for that visit, and all payments made into your account. If you have any questions about your bill, please ask me or our bookkeeper.
INSURANCE: Many but not all insurance plans cover outpatient psychological services. Some require pre-authorization before they will pay for treatment. If you are unsure about your coverage, call your insurance company to determine if your plan covers Outpatient Mental Health Services. It is important that you know whether your insurance plan has a maximum number of visits and/or a maximum on the total charges per year that they will cover, because this may make a difference in setting up a treatment plan. Our office will submit a bill to your primary insurance carrier. It is your responsibility to pay the co-payment and whatever charges your insurance carrier does not pay.
In families in which divorced parents are each legally responsible for a portion of the child's bill, the custodial parent will be considered responsible for the entire bill. We cannot sort out which portion belongs to which parent, nor will we directly bill the non-custodial parent. Duplicate copies of the bill will be provided upon request, but all other arrangements are the responsibility of the custodial parent.
CHANGES TO THIS OFFICE POLICY: From time to time I may change the business policies described in this document; I will attempt to inform you of relevant changes.
INFORMED CONSENT: I hereby authorize Naomi Huddlestone, Ph.D. to render psychological
services to ______. This authorization constitutes informed consent without exception. I have read and understand the Office Policy Statement and have received a copy of this Office Policy for myself.
Please print your name: ______
Please sign your name: ______
Today’s date: ______
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