POLICIES
Payment Policy
Annette Fiedler Counseling will file with insurance as a courtesy. I agree that if my insurance company doesn't pay for my service, I am responsible to pay the bill for services in full. I agree to pay any insufficient fund fees that are incurred. I will be billed for services if payment is NOT received for services and agree to pay within 30 days of the date of billing.
If I am unable to attend the scheduled appointment, I must notify my therapist a minimum of 24 hours in advance. If I cancel on the day of the appointment, I will be charged $30. If I "no show" for the scheduled appointment, I will be charged the fee for the session. I am responsible for all fees assessed due to the cancellation or "no show" of my appointments.
Statement of Confidentiality
I understand and agree that during my visit/treatment at Annette Fiedler Counseling & Associates I must hold any information about other clients whom I may see at the office confidential. I understand that my therapist will hold my confidentiality to the strictest of expectations. I understand/agree that my confidentiality will be breached and that there are limits to confidentiality. My confidentiality will be breached due to the following reasons:
*Abuse/neglect of a child
*Abuse/neglect of an incompetent adult
*Suicidal thoughts, plans, or actions.
*Homicidal thoughts, plans, or actions.
*Psychosis or inability to prevent harm to me.
A copy of HIPPA is available if requested.
Annette Fiedler Counseling & Associates will not share, sell, or promote any personal information without consent.
Consent for Treatment
I voluntarily authorize consent for treatment at Annette Fiedler Counseling & Associates. I am a competent adult or can legally consent to treatment for the named client. I understand that all services and modalities will be discussed with me and that I am the primary person responsible for the success or failure of my treatment. I understand that the progress or lack of progress with my treatment will continue to be evaluated to assess my further treatment needs. I understand that I may be discharged from treatment for failure to follow through with suggested referrals. I may be discharged at the discretion of my primary therapist at any time with 30 days' notice and a referral to another therapist/agency.