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Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

Client Information

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Terms and Policy

Psychological Services
Our first few sessions together will usually involve an evaluation of your needs. By the end of the evaluation, I will be able to offer an overview of what our work will include and provide a treatment plan for you. Therapy calls for an active effort on your part. In order for it to be most successful, you will have to consider the things we talk about both during and between our sessions. I find that for most situations, meeting weekly works well at first, until you learn some coping strategies. Then time between sessions can be longer as you begin to practice your new tools.
Brief therapy does work well for those who are dealing with a temporary crisis, or specific, well-defined issues. In those instances, change can come quickly. Brief therapy is not appropriate for all people however. It takes time to resolve deeper, more complex, long-standing issues. If you find that you do not feel satisfied with the results from just a few sessions, longer-term therapy may prove to be more helpful to you.
( Type Full Name )
( Full Name )
Professional Fees
I have a base fee of $225 per online video or in office session. Cas rate available for those not using insurance. Each session will be 60 minutes in duration. Sessions of different lengths can be negotiated. Please discuss your needs at our first session.

If your case is involved in court, has a guardian Ad Litem (GAL) or attorneys that may need contact with, this contact is not covered if using insurance. All contact with these individuals is billed at $180/hr. If a court appearance is required this is billed at $225/hr. plus mileage to and from the courthouse. An additional addendum is required and must be signed before the first session with Dr. Collett.

Appointment scheduling can occur at the conclusion of each session or at a later date emailing Dr. Collett. If you need to cancel an appointment, please cancel at least 24 hours in advance. Cancellation can be completed by email ( info@accountablefuture.com) or by phone. Otherwise, you will be charged for the session. You will receive an email confirmation of the cancellation for your records.
( Type Full Name )
( Full Name )
Billing and Payment
I accept payments for copays and balances in the form of checks or cash. Fees for services will be paid before the session.  

USING INSURANCE:

You are responsible to verify with your insurance that they cover your sessions and to determine before your first session what your copay is. If your insurance will cover your sessions, your co-pays will be due and payable before each session by personal check or cash.


If you have out-of network benefits, or if your policy sends you the payment checks, you understand that you are fully responsible to reimburse Teresa Collett, LLC for the total that insurance paid you for each session or the total cost of each session ($225.00) if your insurance does not pay or cover the cost. 


If your account has a balance more than 30 days from the date of your session, a service fee of $5.00 and a late charge of 1% of the balance will be added. If you have problems paying your balance then it will be your responsibility to contact us at info@accountablefuture.com and make payment arrangements. 


Account past due more than 60 days will be evaluated and sent to collection. It is imperative that you make financial arrangements with us early to avoid penalties or future collection action.

( Type Full Name )
( Full Name )
Records
The laws and standards of my profession require that I keep treatment records and you are entitled to receive a summary or copy of your records. Because these are professional records, there is a potential for misinterpretation to untrained readers. If you wish to see your record or receive a copy of your records, I do require written notice ( completion of records request form). I would recommend that you review them with me so that we may discuss the contents.

All information disclosed in our sessions together and written records pertaining to these sessions are confidential, protected by law, and will not be revealed to anyone without your written permission; except where disclosure is required by law.


( Type Full Name )
( Full Name )
Using Insurance Benefits

We currently accept the following forms of insurance;  Blue Cross/Blue Shield, GEHA, KFHP, First Choice, Regence, TriCare, VA.

If you choose to utilize your insurance carrier to make payments for services on your behalf and paid directly to Teresa Collett, L.L.C., you understand that it is your responsibility to verify that you have mental health services included in your policy. You understand that you are responsible for any claims that your insurance does not cover. You further understand that if you choose to use insurance, you are required to provide your most updated insurance information for billing purposes. If insurance changes, it is imperative to update this information immediately. Failure to update may result in unpaid claims that you will be responsible to pay. 

Accountable Future will only bill Primary Insurance (if individual has more than one insurance policy).

The involvement of an insurance company can sometimes interfere with the work we do together. Therapy is an important investment that can last a lifetime and I want to ensure that I am working for you, not for them. I am also determined to protect your privacy. Insurance companies require that I disclose information to them that may later affect you with unforeseen consequences. This information will become part of the insurance records and though all insurance companies claim to keep such information confidential, I do not have any control over what they do with it once it is in their possession.
( Type Full Name )
( Full Name )
Confidentiality and Limits
Information shared during your sessions will be held in strictest confidence. There are some exceptions to confidentiality of which you should be aware:

- State law requires that therapists report to local authorities information pertaining to suspected abuse, child, elder, and dependent adult.

- If harm is threatened against yourself or others, I are required to warn the person against whom the harm is directed or take action to protect a person threatening to harm him/herself.

- In certain cases, courts may subpoena therapeutic records.

- If you receive therapy with others present during the session, you may waive your right to hold confidentiality with the information divulged in that session if other persons desire and give written permission to have that information released to a third party (i.e. court)

- A person may permit the therapist to share specific information with other designated individuals by signing a release of information form.
( Type Full Name )
( Full Name )
Consent for Treatment
I hereby give consent for treatment and understand the limits of using insurance and of confidentiality and the financial responsibility I have by seeking treatment.


I have read and electronically signed all policies and procedures. I sign this document in good faith under my own free will and not under duress.

( Type Full Name )
( Full Name )