The following is a detailed explanation of the policies and procedures of my practice. I am happy to answer any questions you might have.
Your appointment time is reserved for you. It is your responsibility to notify me before the time of your appointment at least 48 hours in advance if you are unable to attend. This policy is strictly enforced. Non-emergency cancellations of appointments less than a full 48 hours in advance and “no shows” are subject to full fee for the appointment time. If you arrive more than 15 minutes late for an appointment without notifying me, I will consider the appointment canceled and charge for the session. If you are late for a session or choose to leave early, you will be seen for the remaining time and charged the full fee for the time originally scheduled.
Exceptions to this policy may occur in the case of unforeseen emergencies or serious illnesses/injuries that arise on the same day as the scheduled appointment. An emergency is defined as a major trauma that occurs to the you or an immediate family member (e.g.. Hospitalization, involvement in a car accident, victim of a crime.) Should one of these events occur on the same day as your appointment, please notify me as soon as reasonably possible, as you will be charged the full session fee if it appears that the cancellation is made at the “last minute” unnecessarily. As an additional exception, if you are aware in advance of an upcoming possible conflict with your appointment time, want me to hold the time for you, and will not know until less than 48 hours, I will make every effort to fill the appointment once you notify me and will waive the cancellation fee if I am able to fill the time.
I often have individuals waiting for a consistent weekly appointment slot. Therefore, should you have a weekly appointment slot and cancel twice in a month on more than one occasion for whatever reason, you will be asked to pay in full at the beginning of each month for the total hours for the month in order to hold that slot. In this circumstance, no refunds are available for unused session time regardless of cause. Should you prefer not to pay in advance each month, you will be offered session times as they become available due to cancellations.
Due to the nature of my work, there are times when unforeseen clinical crises or emergencies may arise with other clients, requiring that your appointment be canceled or delayed. When such situations are unavoidable, I will make every effort to inform you at the earliest possible time and reschedule the missed session time, in order to minimize the inconvenience to you.
Even the darkest night will end and the sun will rise.
- Victor Hugo
Payment & Fees
The standard fee for a 60-minute session is $230. Extended session are prorated accordingly, and rates are the same for in-person and telehealth sessions. I generally provide treatment in weekly, 120-minute sessions, unless there is clear, clinically-based rationale to provide shorter and/or less frequent sessions. I have found, as have many of the experts with whom I have trained, that longer, more intensive EMDR and CBT therapy sessions are often significantly more efficient and effective than shorter ones. Each session requires some attention to managing current life stressors, and longer sessions allow for this to be accomplished along with substantially more focused work toward resolving the primary symptoms of concern. My experience has shown me that far more can be accomplished in a briefer period of time through this approach.
Hourly prorated fees will be charged, should the time exceed 15 minutes and/or be necessary at frequent intervals during the course of treatment, for time spent communicating by phone, text, or email regarding treatment issues between sessions, as well as for time spent in consultation and coordination of care with other treatment providers. Hourly prorated fees will be charged should you require written reports of your assessment, treatment goals, or progress, with the minimum charge equal to the fee for a 60-minute session.
I offer a limited number of sessions at a reduced rate for those experiencing financial hardship. Typically, reduced rates are only available to established clients and for a limited period of time. Please bring it to my attention should your financial situation hinder your ability to afford therapeutic services at the standard rate. Court testimony is charged at an hourly rate of twice the standard fee for a 60-minute session, including travel time and with a minimum charge of a full 8-hour day for each day on call for court appearance. No reduced fees are available for court testimony.
You are expected to pay for services at the time they are rendered, unless other arrangements are specifically discussed and agreed upon with me in advance. An additional $10.00 per week will be charged for session fees not paid on the date of service, which will begin to accrue on the day directly following the date of service. I typically process charges using the credit card authorization on file. You are expected to ensure I have a current credit card on file, and you will be informed in advance of any amounts charged to your card. Alternatively, fees may be paid via Zelle transfer, PayPal, or Check. My Zelle account identification is email@example.com or 831-419-5271. PayPal may be accessed via my website, where you may choose to use your personal PayPal account or sign in as a "guest" and enter your credit card information. Checks must be mailed in advance to ensure receipt by the date of service, and there is a $25.00 fee returned checks. Invoices for payment are available at your request.
No Surprises Act: You are entitled to receive this “Good Faith Estimate” of what the charges could be for psychotherapy services provided to you. While it is not possible for a psychotherapist to know, in advance, how many psychotherapy sessions may be necessary or appropriate for a given person, this form provides an estimate of the cost of services provided. Your total cost of services will depend upon the number of psychotherapy sessions you attend, your individual circumstances, and the type and amount of services that are provided to you. There may be additional items or services I may recommend as part of your care that must be scheduled or requested separately and are not reflected in this good faith estimate. This estimate is not a contract and does not obligate you to obtain any services from the provider(s) listed, nor does it include any services rendered to you that are not identified here. You have the right to initiate a dispute resolution process if the actual amount charged to you substantially exceeds the estimated charges stated in your Good Faith Estimate (which means $400 or more beyond the estimated charges). For questions or more information about your right to a Good Faith Estimate or the dispute process, visit https://www.cms.gov/nosurprises/consumers or call 1- 800-985-3059. The initiation of the patient-provider dispute resolution process will not adversely affect the quality of the services furnished to you.
Good Faith Estimate Valid through 8/31/2024: The fee for a 60-minute psychotherapy visit (in-person or via telehealth) is $230. The fee for a 120-minute psychotherapy visit (in-person or via telehealth) is $460. Most clients will attend one psychotherapy visit per week – which in my practice is typically scheduled in 120-minute increments. However, the frequency of psychotherapy visits that are appropriate in your case may be more or less than once per week, depending upon your needs. Based upon a fee of $460 per 120-minute visit, if you attend one psychotherapy visit per week, your estimated charge would be $1840 for four visits provided over the course of one month; $3680 for eight visits over two months; or $5520 for 12 visits over three months. If you attend therapy for a longer period, your total estimated charges will increase according to the number of visits and length of treatment. This estimate is valid through 8/31/2024, as rates for psychotherapy are reviewed each September and may be increased 5-10% annually. This Good Faith Estimate is not intended to serve as a recommendation for treatment or a prediction that you may need to attend a specified number of psychotherapy visits. The number of visits that are appropriate in your case, and the estimated cost for those services, depends on your needs and what you agree to in consultation with me. You are entitled to disagree with any recommendations made to you concerning your treatment and you may discontinue treatment at any time. You are encouraged to speak with me at any time about any questions you may have regarding your treatment plan, or the information provided to you in this Good Faith Estimate.
Insurance Billing & Accounting
I treat my clients' needs according to my clinical training and experience, and my rates are set in accordance with what is usual and customary for my level of expertise and specialization. I have found that the treatment protocols and authorization requirements of insurance companies are restrictive, burdensome, and often inadequate, and that they do not tend to promote my client's receiving adequate and effective treatment. Therefore, as a rule, I do not contract with insurance companies as an In-Network Provider. As a service to you, I am willing to submit basic documentation of services to insurance and other third-party payers, but I cannot guarantee your benefit levels and am not responsible for their payment.
In some cases, insurance or other third-party players may deem certain services as not "reasonable or necessary" or may determine that services will not be covered. You are responsible for payments regardless of any agency’s arbitrary determination of rates or coverage. Should your insurance company require written or verbal justification or pre-authorization for services and you wish for me to provide this information, hourly prorated fees will be charged for all time required to do so including chart review, hold times, and communication of clinical data, understanding that there is no guarantee it will result in subsequent approval by the insurance company.
Insurance billing and accounting is handled by Linda Griebel of Griebel Billing. You are welcome to contact her directly regarding any insurance related questions. Please contact her at the beginning of treatment or any time your insurance changes in order to verify the extent and specifications of your coverage. Insurance companies generally do not send this therapist the Explanation of Benefits for processed claims, so you are also encouraged to monitor the paperwork you receive from your insurance closely and contact Linda if anything appears amiss. Linda can be reached at (619) 224-6343 or firstname.lastname@example.org.
Telephone & Internet Communication
If there is a matter where you need a brief/crisis consultation with me, you may call to discuss the issue. I welcome text messages for practical matters but ask that clinical discussions be handled by phone or in session in order to ameliorate the risk of miscommunication inherent to texting. If anything communicated by text is confusing or troubling, I ask that you bring it to my attention so it can be addressed promptly. As it is challenging between scheduled sessions to ensure I am in a setting in which I can provide adequate privacy and attention to meet your therapeutic needs, hourly pro-rated fees are charged for calls or texting that exceed 15 minutes or become frequent. If significant between-session communication is needed, I will typically recommend scheduling more frequent sessions or provide referrals for additional types of support.
You will be asked to assent to the following:
*I understand that I am requested to use the secure client portal for all messages/texts regarding my therapy (available online via email link or through the SimplePractice Client Portal App). I understand that texting the office at 760-452-2776 is unreliable and may not be received. By entering my cell phone number here, I am consenting to use of my cell phone for texting while acknowledging (1) that I am aware standard texting to this therapist’s iPhone at 831-419-5271 is not a secure form of communication and (2) that my confidentiality and privacy may be at risk when engaging in text communication.
The Client Portal is the preferred platform for all communication. My email address is email@example.com. However, due to the inherent vulnerability of electronic communication, there is no guarantee that email correspondence is confidential. If you wish to communicate via encrypted message, please email me a brief note with this request. I will reply with message enabling encrypted communication via a secure, HIPAA-compliant platform or redirect you how this might be done via the Client Portal. I will generally respond only briefly via email and will, rather, wait until you are face to face to address issues in any depth. Please use my voice mail to communicate any urgent information, as I cannot assure timeliness in reading or responding to email. In order to maintain the clarity of the therapeutic relationship, I will generally not use social networking sites (e.g. Facebook, Instagram, LinkedIn) to communicate with you about clinical issues.
Psychotherapy via Telehealth
Telehealth (also referred to as Telemedicine or TeleMentalHealth) is a mode of delivering health care services, including psychotherapy, via communication technologies (e.g. Internet or phone) to facilitate diagnosis, consultation, treatment, education, care management, and self-management of a patient’s
You have a right to confidentiality with regard to your treatment and related communications via Telehealth under the same laws that protect the confidentiality of your treatment information during in-person psychotherapy. The same mandatory and permissive exceptions to confidentiality outlined elsewhere in this Consent for Treatment also apply to your Telehealth services.
There are risks associated with participating in Telehealth including, but not limited to, the possibility, despite reasonable efforts and safeguards on my part as your therapist, that your psychotherapy sessions and transmission of your treatment information could be disrupted or distorted by technical failures and/or interrupted or accessed by unauthorized persons, and that the electronic storage of your treatment information could be accessed by unauthorized persons. There is a risk of being overheard by persons near you, and you are responsible for using a location that is private and free from distractions or intrusions. Some Telehealth platforms allow for video or audio recordings and neither you nor myself, as your therapist, may record the sessions without the other party’s written permission.
I am required to verify your identity and current location at each Telehealth session. I will make reasonable efforts to ascertain and provide you with emergency resources in my geographic area if they are needed. However, I may not be able to assist you in an emergency situation. If you require emergency care, you may call 911 or proceed to the nearest hospital emergency room for immediate assistance.
You will be asked to assent to the following and to provide the County where you are located and the phone number of your County's non-911 Emergency Phone Number:
* I agree to inform this therapist of the address of my physical location for each Telehealth session.
* I agree to upload a copy of my Photo ID to this portal (e.g. State-Issued ID, Drivers License, Military ID).
While Telehealth has been found to be effective in treating a wide range of mental and emotional issues, there is no guarantee that Telehealth is effective for all individuals. Therefore, while you may benefit from Telehealth, results cannot be guaranteed or assured. Miscommunication between us may occur via Telehealth. In some instances, Telehealth may not be as effective or provide the same results as in-person therapy. If I believe you would be better served by in-person therapy, I will discuss this with you and refer you to alternative services as needed.
The material you disclose is confidential and cannot be released without your written consent.
However, there are several important exceptions to confidentiality. These include:
• If there is reasonable belief or suspicion that child abuse has occurred
• If there is reasonable belief or suspicion that elder or dependent adult abuse has occurred
• If the client makes a serious threat of harm to another person
• If the client demonstrates danger to self or others
• If the client files an insurance claim to be reimbursed for some portion of the cost, this gives the insurance carrier the right to inquire regarding the client
• If the client enters into legal proceedings in which the client raises the issue of his/her mental health status, the court may order the applicable records
• If the client brings a lawsuit against this therapist
• If a judge orders the therapist to release client information
• If the therapist is disclosing medical information to a provider of health care, health care service plan, or contractor for the purposes of diagnosis or treatment of the client.
Should you give written permission to provide information to another party, there is limited confidentiality. In these cases and in most situations listed above, I can reveal information only to someone who has a “need to know”, and entire records or irrelevant information may not be disclosed. Whenever information will be shared with other persons, every effort will be made to ensure that the receiving person also maintains confidentiality.
In addition to the above, special circumstances apply to group, couple, parent-child, and family therapy and any time the client chooses to involve another person in treatment. Specifically, other individuals in the room are not bound by privilege and may possibly not hold all information confidential; I am not responsible for disclosure by these individuals.
Please note that my practice is clinically focused and not designed for legal proceedings or forensic purposes. I generally do not provide court testimony or documentation for the court cases unless legally required to do so. I am not trained as a child custody evaluator or mediator, am unable to make recommendations regarding custody arrangements, and customarily will not provide information to the court or its representatives beyond that which is legally mandated.
You may have access to your treatment records, although it may be best for me to discuss the items contained in the records with you or to provide you with a summary for a specific purpose. Financial records and insurance billing information are maintained in your chart and using the the secure Simple Practice client portal. These records may be managed by administrative personnel, who are under the same obligation to protection of your privacy and confidentiality as your therapist. My administrative personnel may contact you regarding accounting and scheduling issues.
It is important to me that I respect your right to privacy regarding your participation in therapy. Therefore, should you happen to encounter me in the community, I will allow you to initiate and determine the level of acknowledgment.
The Notice of Privacy Practices provides information about how I may use and disclose your protected health information. A copy of the Notice of Privacy Practices is generally made available to you at the time of intake but can be provided to you at any time upon your request. While the critical information is already contained in this Information form, I encourage you to read the Notice of Privacy Practices in full. The Notice of Privacy Practices is subject to change. If I change the Notice of Privacy Practices, you may obtain a copy of the revised notice from me.
When a minor is involved in therapy, I will clarify whether the client is the minor or the family. Minors will be informed that their parents will typically have access to information about their level of participation in treatment, treatment goals, and progress, in addition to any additional information the minor has provided consent to be shared. While a parent may have a right to information revealed by a minor for whom they have consented for treatment, I believe that it is therapeutically beneficial for the minor to be able to choose whether or not to share the disclosures they make in individual sessions with their parents. However, in cases where the safety of the minor or any other person is endangered, I maintain the right to reveal the secret information without the minor’s permission. I ask that parents do not provide me with information pertaining to their child or adolescent's behavior that they do not want revealed to the child or adolescent, as my holding secret knowledge of this type has limited value in achieving therapeutic ends.
If more than one "set" of parents is involved in a minor's treatment or the parents live in separate homes, specific guidelines and expectations will be discussed as to what types of information I will communicate between parental figures pertaining to the minor's treatment.
When members of a couple come in for therapy, I will clarify whether the client is the individual or the couple. As a general rule, secrets are seen as harmful to the effectiveness of treatment for a couple. In situations when a couple is in therapy and secret information is revealed by one person, it is understood that I will not reveal the information to the other party without direct permission. However, in order to facilitate the success of the treatment, I will encourage full disclosure of information between participants. Should either member of the couple insist on maintaining a secret or if revealing the secret information would endanger one of the parties, I may determine that it is not workable to continue couple's therapy at that time and that other options should be explored. Should such a situation arise, I will discuss it with you thoroughly.
She had not known the weight until she felt the freedom.
- Nathaniel Hawthorne
Crisis & Emergency Coverage
I generally respond to voice mail only during my normal business hours, Monday - Friday, from 10am-9pm. Under exceptional circumstances, I may return a call outside of my normal business hours if you are in an urgent, crisis situation. However, I may be unavailable at the time of your call, so there may be a reasonable delay in the ability to respond to your message. Therefore, should you be experiencing an emergency and require immediate assistance, please call 911 or go to the nearest emergency room.
I will assign another qualified therapist to be available and have access to treatment records should this be necessary under specific circumstances when I am not available, such as vacations or planned medical leave. The contact information for this therapist will be provided on my voice mail when appropriate. In the event of my unplanned absence from practice, whether due to injury, illness, death, or any other reason, I maintain a detailed Professional Will with instructions for a group of mental health professionals who will reach out to inform you of my status and ensure your continued care in accordance with your needs. By signing this document you are authorizing these professionals to access your treatment and financial records only in accordance with the terms of my Professional Will, and only in the event that I experience an event that has caused or is likely to cause a significant unplanned absence from practice.
Boundaries of the Therapeutic Relationship
The relationship with me, as your therapist, is solely professional, and it is at risk of becoming confusing, ineffective, or even harmful if clear boundaries around the nature of the relationship are not maintained. This means that I will not engage in close friendship, romantic relationship, sexual contact, or financial/business/employment arrangements simultaneous to acting as your therapist. Sexual contact in any therapeutic relationship should be reported to the State Board. It is often beneficial to maintain these boundaries even after the therapy has ended. As "crossing paths" is possible through the activities and workings of the community, I will take appropriate professional precautions to ensure that my therapeutic judgment is not impaired when such interactions are unavoidable.
You are welcome to like or follow my professional pages on Facebook and Instagram @PrecisionEMDRAcademy, as well as the therapy pets' Instagram account @PenelopePoppiseed. You are under no obligation to like or follow these pages, nor are you under any obligation to like, comment, or share any posts. I will make every effort to maintain your privacy and confidentiality should you comment on any post by responding in a fashion intended to (1) cloak any indication that we have a therapist/client relationship and (2) to protect all content of your treatment. You, however, have the freedom to disclose the nature of our relationship should you so choose. While you may choose to send messages to me over these sites, I will seek to minimize clinically related discussions because of the vulnerability to your privacy and confidentiality on these platforms.
In order to maintain the clarity of the therapeutic relationship, I will generally not use social networking sites (e.g. Facebook, Instagram, LinkedIn) to communicate with you. I may choose to use cell phone, texting, and email communication with you during the course of treatment, and such communication is solely for professional purposes and does not constitute engagement in anything other than a therapeutic relationship. While not typical, there may be clinical reason for me to perform a home visit or conduct a session outside of the office setting, and again this does not constitute anything other than a professional relationship. Should you ever have confusion or concerns regarding the boundaries of your relationship with me, please bring these to my attention immediately.
Termination of Therapy
The length of time you remain in therapy is your decision. I will provide counsel to you on this matter, based on assessment of the presenting issues and the goals established during the course of treatment. Should you be concerned or dissatisfied at any time with the therapy provided, please discuss your concerns with me. It is a high priority for me to meet your therapeutic needs and your communication is essential in order to accomplish this. If it appears that you would attain greater benefit from work with a different therapist, I will provide you with referrals.
Potential Benefits & Risks of Treatment
The process of therapy can involve much comfort and growth, but it may also include difficult, challenging, and even painful emotions and relational experiences. Treatment benefits, while likely, cannot be guaranteed. Every client's experience in therapy is different and the results of treatment can vary greatly. As the work of therapy is inherently a partnership, the outcome is dependent on what all participants contribute. My aim is to use my education and clinical experience to effectively work with you toward your treatment goals. You have a right to participate in your treatment decisions, to seek a second opinion, to file a complaint with your State’s Board without retaliation, and to refuse treatment.
The California Board of Behavioral Sciences receives and responds to complaints regarding services provided within the scope of practice of marriage and family therapists, licensed educational psychologists, clinical social workers, or professional clinical counselors. You may contact the California BBS online at www.bbs.ca.gov or by calling (916) 574-7830. Additional Board Contact information:
Idaho Licensing Board of Professional Counselors and Marriage and Family Therapists: PO Box 83720 Boise, ID 83720-0063; 208-334-3233; IBOL@IBOL.IDAHO.GOV; www:IBOL.Idaho.gov.
Colorado Department of Regulatory Agencies, Division of Professions and Occupations: 1560 Broadway, Suite 1350, Denver, CO 80202; 303-894-7800; dpo.colorado.gov.
Texas State Board of Examiners of Marriage and Family Therapists: 1801 Congress Ave., Ste. 7.300 Austin, Texas 78701; 512-305-7700; 800-821-3205; www.bhec.texas.gov.
Statement Authorizing Consent for Self and/or Minor's Treatment
I understand the above information regarding the nature and limitations of the professional counseling relationship. I understand that copies of any documents containing my signature are available upon my request and that I can access the most updated information regarding treatment policies online at www.susiemorganlmft.com.
I have asked any questions I need to ask in order to understand this document in its entirety, and I understand that I should not sign it until I have had all of my questions answered.
If signing for a minor, I assert that I hold legal custody or legal authorization to consent for the minor’s participation in therapy; the therapist has been informed of all other individuals holding legal custody or legal authorization to consent for the minor's participation in therapy; and that the therapist must be provided with copies of any/all applicable legal documentation pertaining to custody/consent. (Policies updated 7/2022)