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Owens Outpatient Therapy Lori Owens, LCSW
8046 Roswell Rd, Suite 101C Sandy Springs, GA 30350
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Statement of Understanding
Please read the following material carefully. If you have any questions or concerns about this material, I will gladly address them before we begin our session.
Consent and Confidentiality
By seeking treatment with me, you are consenting to treatment under the guiding principles for clinical practice established by the National Association of Social Workers. Your therapy is held under confidence except:
a court order, suspected child or elder abuse, or threat or harm to self or others.
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Appointments
Sessions are 50 minutes. If you cannot keep your appointment, notify me as soon as possible. The time set aside for each individual makes it necessary that a regular charge of $100 will be made for any appointments not cancelled within 24 hours in advance. Please be mindful of this to avoid these charges.A voicemail message is acceptable.
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Fees and Insurance
Payment of $135 per hour due at the time of service. I accept cash, checks and credit cards (additional charge for credit cards). If you have been authorized treatment by your managed care company, you are responsible for your co-payment or deductible not met by your insurance. There is a $35 fee for all insufficient fund checks received, and payment must occur prior to the next scheduled appointment. Payment is due at each session and future appointments will not be scheduled unless balance is paid. If any reports or FMLA forms are needed to be completed, my hourly rate will apply.
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Emergencies
I check my voicemail frequently. If an emergency arises, and I have not returned your call in one hour, please go to the nearest Emergency Room or county mental health center.
Please sign this statement indicating you have read this information. I look forward to working with you.
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Client’s signature Date Therapist’s signature Date