Informed Consent - PAIGE BARTHOLOMEW

PAIGE BARTHOLOMEW

lient/Therapist Agreement and Contract for Service

Please PRINT FOR YOUR RECORDS, as your e-signature binds you to these policies.
Please read through the entire document, and sign at the bottom.

Fees & Payments:
• Weekly, Bi-weekly and Monthly Rates: Weekly appointments are billed at a lower rate than bi-weekly or monthly appointments to help clients afford therapy more often. (Click HERE for information about fees and sliding scales). It is recommended that weekly appointments be maintained for continuity, especially if you're engaged in trauma therapy or hypnotherapy. Bi-weekly or monthly appointments create gaps in Paige's work schedule that are nearly impossible to fill - hence the higher price. Creative scheduling at off-times may be necessary if you would like to meet less than once a week.
• Missed Sessions Must be "Made-Up": Paige suffers from a chronic illness that causes occasional cancellations when flare-ups occur. Therefore, this office offers a creative rescheduling policy as follows: If either YOU or PAIGE cancel or miss a session for any reason (illness, lack of childcare, other emergency or non-emergency), multiple make-up session times will be offered for your convenience. If you are unable to make up your session within 7 days (or before your next appointment), you will be responsible for paying for the cancelled appointment . (Exceptions may be made in certain special circumstances determined by Paige Bartholomew). Every effort will be made by this office to help you attend a "make-up" session, so that your money isn't lost.
• Cancellation due to Illness You will be given 2 'freebies' for illness cancellations per calendar year. After two cancellations, you will be financially responsible for the missed session unless we are able to reschedule within 7 days. Every effort will be made by this office to help you attend a make-up session, so that your money isn't lost.
• Couples' sessions are 90 to 120 minutes long (depending on need), and are billed at a higher hourly rate than individual work.
• Overtime: Often, you may feel that you're work isn't finished at the 65 minute mark. If you need to go into overtime, the time will be provided. A pro-rated charge will be added to your weekly fee for each extra 15 minute increment.
• Payments Venmo and Zelle are the preferred payment methods.
• Emergency sessions (for urgent situations) are available from 10 am to 8 pm, 7 days a week, as Paige is available. If Paige can't fit you in, you may always text or email.
• Your credit card will be kept on file, and is required to hold your appointments. A nominal charge will be made to your credit card upon commencement of work together, to make sure the card is valid and in working order. Your card will never be charged without speaking to you first. Credit card information is locked behind two locks, per Texas law. Your card will reserve the appointments you make, and will be used to cover fees which may be outstanding, such as missed-session fees.
• Insurance Paige is not on any insurance panels, but if you live in the state of Texas, you may request a superbill AT THE END OF EACH YEAR which you may use to file for out of network reimbursement.
* Licensed in Texas: Paige is Licensed as a Marriage and Family Therapist in Texas. If you live outside the state of Texas, Paige will not work for you under the title of "Psychotherapist", but will work under the title of "LIFE COACH".
• Fee increases: This office reserves the right to increase fees at any time, with 5 weeks' notice, given in writing via email. Session fees will go up yearly, every January by $5-$15 per session.

Appointments & Cancellations:
• 24 BUSINESS HOURS' notice is required to cancel or reschedule an appointment.
• We will agree to a weekly standing appointment. It is your responsibility to keep that appointment. If you miss it for any reason, you'll be given every opportunity to re-schedule the session before your next weekly session. If you don't take the opportunity to make up the session, you will still be responsible for the fee. This office will go above and beyond to serve you, offering make-up appointments, as Paige is available.
• The first 16 sessions will be scheduled weekly in order to build our relationship with rapport and trust. These first 16 consecutive weeks are critical to mastering the hypnosis work, and creating a trusting, close connection..
• Modes of Communication: Text is my preferred modes of communication, and are the fastest way to get in touch. Paige does not check phone messages. Please do not call and leave one. You may email at [email protected].
• Hours of Operation:: Sessions are scheduled on Texas time, or the “Central" time zone between the hours of 10 am and 9 pm, Central time. If you live overseas, please know that your session may be very early or very late when time zones don't match up. Paige's caseload is typically full. Often clients must take whatever session time is available - even if it is not convenient to their own schedule. This office will do it's best to accommodate your needs with the appointment openings that exist.
• Confidentiality: Therapists are bound by law to keep everything you say completely confidential. The exception to this is Couples work. When working with a couple - all cards will be kept on the table, at all times. All parties will agree that no secrets will be kept from the therapy work. Paige will not keep secrets from your partner. Paige is required by law not to share couples' information outside the couple sessions.

What will be expected of you?
• You are in charge of your personal growth program. If you are struggling in therapy, it's your job to say something. If you don't like a certain exercise or practice - speak up. If you'd like to go in a different direction - tell Paige immediately. It is your job to advocate for your needs and wants. HELP YOUR THERAPIST HELP YOU.
•How long therapy will take? Many issues can be addressed within short-term therapy (about 12 - 16 sessions), but more serious issues such as trauma, long-standing grief, relationship issues, childhood issues, abuse or addictions typically respond better to longer-term therapy. A good rule of thumb is that it takes one year of clinical work for every decade lived in a state of distress, pain, irresolution or dysfunction. If you work with Paige, plan on longer-term therapy (6 - 24 months).

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Complaints: If you would like to make an official complaint to the Texas Board of Licensed Marriage and Family Therapists, please write to:
Complaints Management and Investigative Section
P.O. Box 141369
Austin, Texas 78714-1369

"I understand that this form is required BEFORE my first session. If the form isn’t submitted on time, the session will be rescheduled. My signature acknowledges that I have read, understood, and agree to the contents of this informed consent ."

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