Steve Hammil Counseling

Disclosure Statement, HIPAA and Agreement for Services


Steve Hammil, MA, LMHC

1730 Minor Ave, Suite 1140

Seattle, WA 98101







Phone: 206.661.2854

Quick Look

Here is the heart of Disclosure, Health Insurance Portability and Accountability Act, and policies of Steve Hammil Counseling.


ü  Nothing you tell me can be disclosed to another party without your written permission except when I have good reason to believe you intend to kill yourself or someone else; the courts subpoena my records; and/or you sue me for malpractice.

ü  If you are in couples counseling I will not disclose information said in either joint sessions or individual sessions to another party without the written permission of both partners.

ü  You will not include me in any legal proceedings should you decide to divorce or separate.

ü  You acknowledge that email and texting are not secure means of communicating and I cannot guarantee confidentiality should you choose to use them.


ü  I have the right to consult with other medical and legal professionals including the sharing of your information, but I will not do so without your written permission.

ü  You have the right to restrict with whom I share information.

ü  You may request an accounting of any and all disclosures.

ü  You have the right to confidentiality as described above

ü  If you suspect a violation of these rights you can file a complaint with me and/or the Washington State Department of Health.

Steve Hammil Counseling:

ü  Licensed Mental Health Counselor, MA Psychology from Antioch University Seattle

ü  Please give 24 hours advanced notice of cancellations. If you cannot, then reschedule if at all possible. If not, then please pay for the missed session.

ü  If you are in couples counseling and I meet with you individually that information may be brought into the couple’s sessions if I think it’s important to the outcome, but only after we have discussed it.

ü  You have the right to refuse any mode of therapy I propose. I will work with you to find one that is acceptable to you.

ü  Note that insurance claims require a diagnosis.



This document is intended to provide important information to you regarding our work together. Please read the entire document carefully and be sure to ask me any questions that you may have regarding its contents.

About Me

I am a Master’s level therapist. I am licensed with the state of Washington (LH60241738) to perform mental health counseling services. This means I have completed all my graduate level coursework, an intensive internship, two years of supervised post graduate training and now have the highest license available to master’s level practioniers. I have been seeing clients for seven years starting with my first client in my practicum in 2007.

I am a member of the American Counseling Association (ACA), the Society for the Exploration of Psychotherapy Integration (SEPI); the Association of Contextual Behavioral Scientists (ACBS); the International Association of Trauma Processionals (IATP); and the International Society for The Study of Trauma and Dissociation (ISSTD).

What Is Counseling and How Does It Work?

I view counseling as a process of working through emotional problems that compromise important aspects of our lives. Its goal is to empower you to achieve a richer life and more fulfilling relationships. The process of change will be unique to your particular situation. The ways in which your history has helped to shape who you are as a person will help to determine the ways in which you will engage in the counseling process.

The process of change begins by defining the problem(s) or issue(s), addressing connected thoughts and feelings, understanding the origin of the problem and developing strategies for resolving it. These strategies may include emotional release, developing important perspectives that can help clarify the problem, enlisting specific support systems and taking concrete steps in the direction of freeing oneself from the constraints of the problem and the emotional history that generated it.

Counseling has potential emotional risks. Approaching feelings or thoughts that you have tried not to think about for a long time may be painful. Making changes in your beliefs or behaviors can be scary, and sometimes disruptive to the relationships you already have. You may find your relationship with me to be a source of strong feelings. It is important that you consider carefully whether these risks are worth the benefits to you of changing. Most people who take these risks find counseling helpful.

My Training and Approach to Counseling

I earned an M.A. in Psychology from Antioch University in Seattle, Washington. I have taken continuing education courses and workshops in a number of areas related to my practice. I regularly participate in my own counseling for personal and professional growth. My approach is an integrative one. I believe in the unity of cognition, affect and behavior and respect for the whole person. As a result my thinking is informed by cognitive, emotion focused, behavioral and relational theories integrated through their common factors and evidence based practices.

Please note that due to the varying nature and severity of problems and the individuality of each client and their goals I am unable to predict the length of counseling or to guarantee a specific outcome or result.


The length of counseling and the timing of the eventual termination of our work together depend on the specifics of the counseling plan and the progress you achieve. We will discuss a plan for termination as you approach the completion of your goals.

You may discontinue counseling at any time. If either you or I determine that you are not benefiting from counseling, either of us may elect to initiate a discussion of your counseling alternatives. Alternatives may include, among other possibilities, referral, changing our approach, or terminating your counseling.

Although you will normally will be the one who decides when counseling will end, there is one exception: If I am not, in my judgment, able to help you, because of the kind of problem you have or because my training and skills are not sufficient, I will inform you of this fact and refer you to another therapist who may be more competent to meet your needs.

Fees and Financial Items

My fee is 105.00 dollars per session. Your fee will be negotiated at our first meeting. I accept First Choice Health, Cigna, Regance and Group Health insurance. I am an out of network provider for all others at this time.

Fees are payable at the time that services are rendered. Although I am happy to assist your efforts to seek insurance reimbursement by providing you with a record of services rendered, I cannot guarantee whether your insurance will provide payment for the services provided to you. Please discuss with me any questions or concerns that you may have about this. You should also know that if you seek reimbursement you will be asked for a diagnosis by the insurance company. A diagnosis is a technical description of the nature of your problems and an indication of whether they are short or long term. I only use a diagnosis if required to by you for insurance purposes. In any case I will discuss it with you in full at the time of your request.

Appointment Scheduling and Cancellation Policies

Sessions are typically scheduled to occur one time per week at the same time and day if possible. Your consistent attendance greatly contributes to a successful outcome. In order to cancel or reschedule an appointment, you are expected to notify me at least 24 hours in advance of your appointment. If you do not provide me with at least 24 hours notice in advance, you are responsible for payment for the missed session.

Counselor Availability/Emergencies

You may leave a message for me at any time on my confidential voicemail. If you wish me to return your call, please be sure to leave your name and phone number(s), along with a brief message concerning the nature of your call.

Telephone consultations between office visits are welcome. However, I will attempt to keep those contacts brief due to my belief that important issues are better addressed within regularly scheduled sessions. Calls that exceed 10 minutes in length will be billed at 2.00 dollars per minute.

Non-urgent phone calls are returned during normal workdays (Monday through Friday) within 24 hours. If you have an urgent need to speak with me, please indicate that fact in your message. 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.

Counselor’s Limited Availability

The will be times when I have limited availability do to travel, illness, or personal commitment. These will be communicated directly to you whenever possible and through my outgoing voicemail message when not possible. You may leave a message for me at any time on my confidential voicemail. If you wish me to return your call, please be sure to leave your name and phone number(s), along with a brief message concerning the nature of the situation.

If you have an urgent need to speak with me, please indicate that fact in your message.

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.

Counselor Communications

I may need to communicate with you by telephone, mail, or other means. Please tell me your preference at our first session. Please be sure to tell me if you do not wish to be contacted at a particular time or place or by a particular means and whether or not it is okay to leave a message.


Your Rights and Responsibilities

Confidentiality and Consultation

You have a right to confidentiality. All communications between us will be held in strict confidence unless you provide written permission to release information about our work. If you are participating in marital or family counseling, I will not disclose confidential information about your counseling unless all person(s) who participate in the counseling with you provide their written authorization to release. In addition, I will not disclose information communicated privately to me by one family member, to any other family member without written permission.

There are exceptions to confidentiality. Under the provisions of the Health Care Information Act of 1992, I may legally speak to another health care provider or a member of your family about you without your consent, but I will not do so unless the situation is an emergency. I will always act so as to protect your privacy even if you release me in writing to share information about you. If I confer with colleagues about your situation, your identity will not be revealed.

The Federal Health Insurance Portability and Accountability Act requires that I protect your confidentiality in all electronic transmission of information about you. Please be aware that the confidentiality of email messages between us cannot be guaranteed.

There are legal exceptions to your right to confidentiality. They are:

·  I have good reason to believe that you will seriously harm another person. In this case I must attempt to warn that person of your intentions and contact the police and ask them to protect your intended victim.

·  If I have good reason to believe that you are abusing or neglecting a child or vulnerable adult, or if you give me information about someone else who is doing this, I must inform Child Protective Services within 48 hours and Adult Protective Services immediately.

·  If I believe that you are in imminent danger of harming yourself, I may legally break confidentiality and call the police or county crisis team.

·  I am subpoenaed by the Secretary of the Department of Health with regard to a regulatory investigation.

·  I am subpoenaed by the Judicial System regarding a legal action that involves you.

·  You sue me for malpractice.

·  In addition, a federal law known as The Patriot Act of 2001 requires therapists (and others) in certain circumstances, to provide FBI agents with books, records, papers and documents and other items and prohibits the therapist from disclosing to the client that the FBI sought or obtained the items under the Act.

Policies Specific to Couple and Family Counseling

·  If you and your partner are in couples counseling with me and either or both of you wish to add individual sessions, what you say in those sessions will be considered to be a part of the couples counseling and may be addressed in joint sessions unless I judge the consequences of so doing will be harmful.

·  If your relationship is a contentious one and dissolution is in the picture, I expect you to agree to refrain from any attempt to include me in legal actions between you, as it compromises the collaborative relationship we must establish in order to assist you in resolving your issues in a satisfactory manner.


·  You understand that there may be times when I may need to consult with a colleague or another professional, like an attorney, about issues raised by me in counseling. Your confidentiality is still protected during consultation by me with other professionals. Your signing of this disclosure statement gives me permission to consult as needed to provide professional services to you as the client.