Policies and Procedures

Office Hours

Monday through Wednesday from 10:00 AM to 7:00 PM

Saturdays 9:00am-3:00pm

Confidentiality 

Any confidential information disclosed during treatment, or any other confidential information I obtain while attending to you professionally, shall be held in confidence unless you permit me to disclose such information or where we are required to disclose such information by law. Some examples include, but are not limited to the following: 

– child/elder/vulnerable person abuse

 – imminent threat of danger to oneself or others

 – court order/subpoena

 – if a mental illness prevents you from providing for your own basic needs such as food, water, shelter, I will be required to disclose information in order to seek hospitalization

 – if there is reasonable degree of certainty that the client cannot operate a motor vehicle or heavy machinery due to epilepsy, dementia, TBI, drug or alcohol intoxication, or any other cognitive or physical dysfunction

Communication and After Hours Policy

1. My preferred method of communication is through e-mail Jhoana@calmacounselingservice.com.  My business phone number is (909) 235-6237.  You will get the fastest and most complete response if you state your concern by sending a brief message through e-mail.  Messages received through e-mail or phone are checked daily during office hours (Monday, Tuesday, & Wednesday from 9:00 AM to 6:00 PM). 

2. Messages received after hours, on weekends, or holidays are reviewed the next business day. Please allow at least 1-2 business days for a response for such messages.

3. I will respond to treatment or clinically-related correspondences during our designated therapy hour in an effort to preserve your confidentiality and appropriate boundaries.  (Brief scheduling, payment, administrative, or other non-clinical correspondences are examples of what I am willing to discuss outside of your reserved therapy hour).

4. Please do not send a message through e-mail or by phone that is of a crisis or emergent nature. Please note if you need immediate assistance, are having suicidal, self-harm, or homicidal thoughts, or any emergency, call 911 or utilize your Safety Plan as developed/discussed with me during session. You may also call 800- 273-TALK, or text 988.  Please feel free to let me know during session if you need guidance or reminders of the mental health crisis hotlines or resources in your area.  

No Shows/Late Cancellations/Late Arrivals

1. If you are unable to attend your scheduled appointment, please e-mail me at Jhoana@calmacounselingservice.com at least 24 hours in advance (excluding weekends and holidays).   If you contact me with at least 24 hours’ notice, you may reschedule with no additional cost, and the appointment will be offered to someone else. For example, if your appointment is on a Monday, the cancellation must be made by the same hour on the preceding Friday. Weekend appointments must be cancelled by the same hour on the Friday before the appointment. If an appointment is not cancelled or rescheduled with at least 24 hours’ notice, the standard appointment fee will be charged.  (Health insurance users- no-show or late cancellation fee is $100).

2. Should you arrive more than 15 minutes late for any appointment, you will be asked to reschedule so that an appropriate amount of time and attention may be devoted to your treatment. You will still be responsible for payment of the missed session if you arrive more than 10 minutes late for any appointment. 

3. Failure to show for your appointments (or violation of the cancellation policy) on two or more occasions may be grounds for dismissal from my practice. Note that the fee may be waived in special circumstances, determined on an individual basis (eg: medical emergency, unforeseen circumstances- clients may be asked to provide documentation). 

4. For my part, I will make every effort to provide you with adequate notice if I will be unavailable for a scheduled appointment and will work to reschedule your appointment in a timely fashion.

Payment for Service 

1. Please note that you are ultimately responsible for all charges incurred for your treatment or the treatment of those for whom you are responsible, at the time of service, unless otherwise agreed upon in writing. You may pay via debit/credit card utilizing Ivy Pay.  

2. You are responsible for fees from banks due to non-sufficient funds, payment disputes, or non-payment of fees. Please notify me if there is any change in your payment information or if any problem arises in your ability to make payments.

3. Fees are subject to change and reflect the complexity and type of service(s) provided. You will be notified thirty days in advance of any changes in my fees.

4. Clients using health insurance: If you have a copay, please ensure it is paid at the time of service.  *No-show or late cancellations of appointments are NOT covered by insurance and are your responsibility to pay.  No-show or late cancellation fee is $100 unless otherwise discussed in extenuating circumstances.

5. Basic Fees for Immigration Psychological Evaluations

   $990- $2,000

              - Please schedule a consultation call for more information on fee schedules.

              - Insurance does NOT cover immigration evaluations.

              - Rush services may be available for an additional $700 (interviews and assessment                                completed within 3-5 business days)

6. Basic Fees Individual Therapy: 

   • Initial Intake Assessment: $175 (60 minutes)

   • Standard Psychotherapy Session (50 min): $150

   • Brief Psychotherapy Session (25-45 min): $125

   • Phone calls: $40 per 10 minutes (phone calls under 5 minutes are not charged) 

   • Miscellaneous professional services per 10 minutes: $40 

   • Bounced / invalid / returned check: $50 

   • Straightforward letter: $20

Mental Health Crisis Management

Crisis Management: I do not provide crisis management or emergency behavioral health services, unless the crisis occurs during your designated session time. If you are in crisis, are having suicidal or homicidal thoughts, or have any emergency, please call 911 or go to your nearest emergency room. You may also call 800- 273-TALK, or text 988, or utilize the Safety Plan we have established during your treatment sessions.

Medical Record Requests, Letter, and Forms 

I will try to complete all work during our scheduled sessions. It may occasionally be necessary for me to charge on a prorated basis for professional services that require extensive time commitment such as report/letter writing, completing forms, telephone conversations lasting longer than 5 minutes, and consultations with other professionals that you have requested. Medical records requested for your own use carry a charge and may be provided in the form of a treatment summary at my discretion and if you are in agreement. Parts of your record that could potentially be detrimental to your psychological well-being may be withheld.  Please allow for at least two weeks for processing of records/letters/forms requests.

Forensic Affairs

 If I am subpoenaed to appear in a court action involving the care that was delivered to you, you will be charged a fee for court appearances. Please note the fees related to court cases (preparing for depositions, travel time, court time, etc.) are billed at a higher hourly rate than basic services.  

Audio or Video Recording Policy

Please be aware that the audio or video recording of any session is not permitted secondary to therapeutic and privacy issues. If an unauthorized recording is made, it is grounds for immediate termination of the therapeutic relationship.

CHANGES TO THIS NOTICE

I reserve the right to change this notice. I reserve the right to make the revised notice effective for medical information we already have about you as well as any information we receive in the future. This Agreement shall not be amended except by written understanding and signature by both parties (client and Calma Counseling Services). Should any provision of this Agreement be declared void or ineffective by virtue of any state or federal statute or regulation, or decision of any court or regulatory authority, such declaration shall not invalidate any of the provisions of this Agreement that otherwise remain in full force and effect. By signing below, you certify that you have read and understand the terms stated in this Policies and Procedures Treatment Consent Form. You agree to abide by the terms stated above throughout the course of the professional relationship.