Helping Us Work Together
Understanding What to Expect: Please acknowledge your review of this material and electronically sign when complete.  Please print out the information if needed or it can be accessed at my website journeywellnesscounseling.com
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Cancellation Information
The appointments, whether telehealth or in-office, are at times reserved exclusively for you. If for any reason you need to cancel, I require 24 hours prior to your appointment.  In the event that you cannot cancel 24 hours in advance, you will be charged $150 for the missed appointment.  This charge is not billable to insurance. If you neither cancel, nor appear for your appointment, you are responsible to pay the full fee for the missed appointment. If you fail to attend, without proper notification, for two scheduled appointments in a 30 day period, I also reserve the right to discontinue service.
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Payment
Payment, or co-pay, is requested at the beginning of the day of your session unless otherwise arranged. 
You can expect your IVY PAY account to be charged the morning of the day of your appointment.  Initial assessments must be paid in advance, before commencing treatment.  
IVY PAY is used to pay for sessions. The fee may also be paid with cash, personal check, or money order.
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Tardiness
Each individual session/clinical hour is 50 minutes long unless prearrangements have been made. Each session begins at your scheduled appointment time. Prompt arrival for your appointment is in your best interest and if you are more than 15 minutes late, your appointment will be canceled and you are still responsible for full payment. 
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Receipt and Acknowledgment of Notice of Privacy Practices

Confidentiality is one of the most important components between a client and therapist. Successful therapy requires a high degree of trust with highly sensitive subject matter that is usually not discussed anywhere but during the session. You can expect that what you discuss in session will not be shared with anyone except when state law, HIPAA, and professional ethics require exceptions. The following situations are required exceptions to confidentiality:

*  Suspected past or present abuse or neglect of children, adults, and elders.

*  If the therapist has reason to suspect the client is seriously in danger of harming him/herself or has threatened to harm another person.


Anyone engaging in treatment needs to read Journey Into Wellness Counseling Services LLC, NOTICE OF PRIVACY PRACTICES.

I hereby acknowledge that I have been given an opportunity to read a copy of Notice of Privacy Practices. I understand that if I have any questions regarding the Notice or my privacy rights, I can contact Julie Wells LCSW, CP, TEP at 727-688-5800 or PO Box 464, Crystal Beach, FL, 34681. I will request a copy of this policy if needed.   
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Good Faith Estimates
The purpose of a GFE is ensure that clients are aware of the cost of therapy could be without having or using insurance. 
Weekly therapy sessions for one year, at a rate of $150 per session, would amount to a total cost of $7,800.
Bi-weekly (every other week) therapy sessions for one year, also at $150 per session, would total $3,900.
Monthly therapy sessions for one year, at $150 per session, would have a total cost of $1,800.

LEGAL/COURT INVOLVEMENT

● I understand that if I enter into treatment with Julie Wells, I am agreeing not to involve Journey Into Wellness Counseling Services in legal/court proceedings or to attempt to obtain records of treatment for legal proceedings. This prevents misuse of my treatment for legal objectives.  The goal is to support me in achieving therapy goals, not to address legal issues that require an adversarial approach.

 

● In situations requiring court involvement, the fee is $750 per hour for court appearances and $750 per hour for preparation for court testimony including, but not limited to, consulting with attorneys, reviewing the file, report/letter writing and time spent traveling to court and waiting to testify. In addition, since an entire day of clients would need to be cleared for attendance at court, a full day of 8 hours @ $750 per hour for each day of court or deposition request will be charged. There are additional fees for parking and mileage. A retainer for court expenses will be due and payable a minimum of two weeks prior to a scheduled court appearance. In the event of a settlement or cancellation of the trial/hearing with less than 48-hour notice, a charge will be levied for those hours originally set aside for the trial/hearing. These services are not reimbursable by your medical insurance.

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I acknowledge that I have reviewed this information and I accept and understand the information.  I understand that I can ask questions at any time and am encouraged to maintain open communication to clarify any concerns or questions. 
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