Dr Dan Paratore, Psychologist PC

Your Well-Being Is in Good Hands

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Welcome, please read and return to Dr Dan: Therapy Contract

Welcome to my practice. This document contains important information about my professional services and business policies. Please read it carefully and jot down any questions you might have so that we can discuss them at our next meeting. When you sign this document, it will represent an agreement between us. Psychological Services/Psychotherapy is not easily described in general statements. It varies depending on the personalities of the psychologist and client and the particular problems brought forward. There are many different methods I may use to deal with the problems that you hope to address. Psychotherapy is not like a medical doctor visit. Instead, it calls for a very active effort on your part. In order for the therapy to be most successful you will have to work on things we talk about both during our sessions and at home. Psychotherapy can have benefits and risks. Since therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. On the other hand, psychotherapy has also been shown to have long-range benefits for people who go through it. Therapy often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress. The techniques I employ are scientifically driven and evidenced-based, but there are no guarantees of what you will experience. Our first few sessions will involve an evaluation of your needs. By the end of the evaluation, I will be able to offer you some first impressions of what our work will include and a treatment plan to follow. You should evaluate this information along with your own opinions of whether you feel comfortable working with me. Therapy involves a large commitment of time, money and energy, so you should be very careful about the therapist you select. If you have questions about my procedures we should discuss them whenever they arise. If your doubts persist, I will be happy to help you set up a meeting with another mental health professional for a second opinion.

Meetings- I normally conduct an evaluation that will last from 2 to 3 sessions. During this time, we can both decide whether I am the best person to provide the services you need in order to meet your treatment goals. If psychotherapy is begun, I will usually schedule one 30 minute session per week at a time we agree on, although some sessions may be more or less frequent, especially depending upon clinical presentation. Once an appointment is scheduled, you will be billed for it unless you provide no less than 24 hours of advance notice of cancellation [unless we both agree that you were unable to attend due to circumstances beyond your control]. * * Cancelling with a psychologist short notice is tricky business because I have reserved an hour of time just for you; unlike a general practitioner typically serving five or six people in an hour.

Professional Fees- Unless we agree to go through third party payment (insurance), my initial (diagnostic interview) fee is 250.00.  Ongoing sessions will be billed at 200.00.  Again, to be clear these are my private fees and if you decide to use your health insurance you will only be responsible for copays/deductibles, etc.  We should discuss this at the start but remember, it is your responsibility to know your plan!  In addition to weekly appointments, I charge this amount for other professional services rendered. Other services include consultation, evaluation/assessment, report writing, telephone conversations lasting longer than 20 minutes, attendance at meetings with other professionals you have authorized, preparation of records or treatment summaries, and the time spent performing any other service you may request of me. If you become involved in legal proceedings that require my participation, you will be expected to pay for my professional time even if I am called to testify by another party. Because of the difficulty of legal involvement, I charge 500.00 per hour for preparation and attendance at any legal proceeding. I reserve the right to decline your request to participate in legal proceedings as a) my testimony may likely be viewed as bias due to our therapy relationship, and b) the testimony might affect our therapy relationship, and ethically, I must put this relationship first. If any legal elements are imminent or pending I expect full disclosure on your part as early as possible. Billing and Payments You will be expected to pay for each session at the time it is held. Payment schedules for other professional services will be agreed to when they are requested. [In circumstances of unusual financial hardship, I may be willing to negotiate a fee adjustment or payment installment plan]. If your account has not been paid for more than 30 days and arrangements for payment have not been agreed upon, I have the option of using legal means to secure the payment. This may involve hiring a collection agency or going through small claims court. If such legal action is necessary, its costs will be included in the claim. In most collection situations, the only information I release regarding a client’s treatment is his/her name, the nature of services provided, and the amount due.

Contacting Me: I am less often available by telephone, but text message is quicker.  When I am unavailable my voice mail will activate. I will make every effort to return your call on the same day you make it, with the exception of weekends and holidays. If you are difficult to reach, please inform me of the times when you will be available. If you are unable to reach me and feel that you can’t wait for me to return your call, contact your family physician or the nearest emergency room and ask for the clinician/psychologist/psychiatrist on call. If I will be unavailable for an extended time, I will provide you with the name of a colleague to contact, if necessary.

Professional Records: the laws and standards of my profession require that I keep treatment records. You are entitled to receive a copy of your records, or I can prepare a summary for you instead. Because these are professional records, they can be misinterpreted by and/or upsetting to untrained readers. If you wish to see your records, I recommend that you review them in my presence so that we can discuss the contents. Clients will be charged an appropriate fee for any professional time spent in responding to information requests. Minors If you are under 18 years of age, please be aware that the law may provide your parents the right to examine your treatment records. It is my policy to request an agreement from parents that they agree to give up access to your records. If they agree, I will provide them only with general information about our work together, unless I feel there is a high risk that you will seriously harm yourself or someone else. In this case, I will notify them of my concern. I will also provide them with a summary of your treatment when it is complete. Before giving them any information, I will discuss the matter with you, if possible, and do my best to handle any objections you may have about what I am prepared to discuss. Confidentiality In general, the law protects the privacy of all communications between a client and a psychologist, and I can release information about our work together only with your written permission. But there are a few exceptions. In most legal proceedings, you have the right to prevent me from providing any information about your treatment. In some proceedings involving child custody and those in which your emotional condition is an important issue, a judge may order my testimony if she or he determines that the issues demand it. There are some situations in which I am legally obligated to take action to protect others from harm, even if I have to reveal some information about a client’s treatment. For example, if I believe that a child [elderly person, disabled person] is being abused, I may be required to file a report with the appropriate state agency. If I believe that a client is threatening serious bodily harm to another, I am required to take protective actions. These actions may include notifying the potential victim, contacting the police, or seeking hospitalization for the client. If the client threatens to harm him or herself, I may be obligated to seek hospitalization for him or her, and to contact family members or others who can help provide protection. These situations have rarely occurred in my practice. If a similar situation occurs, I will make every effort to fully discuss it with you before taking any action. I may occasionally find it helpful to consult other professionals about a case. During my consultation, I make every effort to avoid revealing the identity of my client. The consultant is also legally bound to keep the information confidential. If you don’t object, I will not tell you about the consultations unless I feel that it is important to our work together.

Exceptions to confidentiality that you should know include: a) your name and address may be sent to a collection agency if I am unable to collect fees, and b) your right to confidentiality will be waived if you file an official lawsuit or complaint against me. While this written summary of exceptions to confidentiality should prove helpful in informing you about potential problems, it is important that we discuss any questions or concerns that you may have at our next meeting. I will be happy to discuss these issues with you if you need specific advice, but formal legal advice may be needed because the laws governing confidentiality are quite complex. Your signature below indicates that you have read the information in this document and agree to abide by its terms during our professional relationship. 

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(Sign/email or text your acknowledgement.. ask Dr Dan for your 4 digit patient ID)

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Signature: _____________________________________________________ Name (printed): ________________________________________________ Date:  ____________________________________

Dan Paratore, Ph.D. NYS Licensed Clinical Psychologist 018300

Certified NYS School Psychologist 875798

NYS DOH Early Intervention Provider 25700

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