THERAPIST DISCLOSURE
Your therapist, Altagracia "Grace" Padilla, M.A., is a Registered Associate Marriage and Family Therapist #125138. Grace holds a Master’s degree in the field of clinical psychology and is completing hours towards licensure as a Marriage and Family Therapist (MFT). As required by the California Board of Behavioral Sciences, all pre-licensed therapists are supervised by a licensed MFT.

The supervising therapist is Ashley McDaniel, M.A., LMFT, Licensed Marriage and Family Therapist #115550.

SESSION POLICY
Standard therapy sessions are 50 minutes. A longer therapy session of 90 minutes is available at the recommendation of your therapist which is based on each clients' individualized needs and the therapist's availability. Subject to different session fee.

PAYMENT POLICY
The individual therapy fee is $150.00 per 50 minute session or $200 per 50 minute couples session, payable in CASH, CHECK (made out to Ashley McDaniel) or online INVOICE sent to you via email. Fees are payable at the time that services are rendered. Please make your payment at the beginning of each session if you are paying with CASH or CHECK. Checks made out before the session will insure that your therapy time is not taken up with check writing. Otherwise an online INVOICE will be sent to your email on file at the end of your session.

If for some reason you find that you are unable to continue paying for your therapy, you should inform your therapist. Your therapist will help you to consider any options that may be available to you at that time.

All sessions 50 minutes and less are subject to being charged the full session fee. 90 minutes sessions fees will be disclosed prior to the session being rendered.

If using health insurance, you will receive a superbill each month which includes all the information for your insurance company to reimburse you. At this time, your therapist does not take insurance.

CANCELLATION POLICY
If you need to cancel your appointment, please give at least 48 hours notice (preferably as soon as possible as others are desiring to book appointments). Appointments that are cancelled within 24 hours will pay a cancellation charge equal to the session fee.

CONFIDENTIALITY AND LIMITS TO CONFIDENTIALITY
All information disclosed within session is confidential and may not be revealed without your written permission except where disclosure is required by law, such as:
a) there is a reasonable suspicion of abuse of children
b) there is a reasonable suspicion of abuse of elderly/dependent adult
c) the client presents a serious danger of violence to others
d) the client is likely to harm himself/herself unless protective measures are taken

It is important that you know that your therapist utilizes a “no-secrets” policy when conducting family or marital/couples therapy. This means that if you participate in family, and/or marital/couples therapy, your therapist is permitted to use information obtained in an individual session that you may have had with him or her, when working with other members of your family. Please feel free to ask your therapist about his or her “no secrets” policy and how it may apply to you.

FILING A COMPLAINT
The Board of Behavioral Sciences receives and responds to complaints regarding services provided within the scope of practice of Marriage and Family Therapists. You may contact the board online at www.bbs.ca.gov, or by calling (916) 574-7830.

SOCIAL MEDIA POLICY
Although I do have social media sites, which you can visit and get information from, I do not contact or communicate with my clients through social media platforms, such as Facebook, Instagram, YouTube, etc. This is to protect your privacy.

ADMINISTRATIVE PROCESSES AND YOUR PROTECTED HEALTH INFORMATION (PHI) POLICY
Your therapist utilizes G Suite for all documentation and administrative processes. This private practice has signed the required Business Associate Agreement (BAA) with Google to be Health Insurance Portability and Accountability Act (HIPAA) compliant, which keeps your health information protected and safe.

TREATMENT & TERMINATION OF SERVICES POLICY
It is your therapist’s intention to provide services that will assist you in reaching your goals. Based upon the information that you provide to your therapist and the specifics of your situation, your therapist will provide recommendations to you regarding your treatment. We believe that therapists and patients are partners in the therapeutic process. You have the right to agree or disagree with your therapist’s recommendations. Your therapist will also periodically provide feedback to you regarding your progress and will invite your participation in the discussion. Over the course of therapy, your therapist will attempt to evaluate whether the therapy provided is beneficial to you. Your feedback and input is an important part of this process. It is the goal of your therapist to assist you in effectively addressing your problems and concerns. However, due to the varying nature and severity of problems and the individuality of each patient, your therapist is unable to predict the length of your therapy or to guarantee a specific outcome or result.

The length of your treatment and the timing of the eventual termination of your treatment depend on the specifics of your treatment plan and the progress you achieve. It is a good idea to plan for your termination, in collaboration with your therapist. Your therapist will discuss a plan for termination with you as you approach the completion of your treatment goals.You may discontinue therapy at any time. If you or your therapist determines that you are not benefiting from treatment, either of you may elect to initiate a discussion of your treatment alternatives. Treatment alternatives may include, among other possibilities, referral, changing your treatment plan, or terminating your therapy.

GOOD FAITH ESTIMATE
You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services. You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.