Mandy Attaway, MA, LMFT-A

mattaway@bridgesofhope.net (817) 969-4643

Under Supervision by:

Gwen Bain, M.A. LPC-S, LMFT-S

gbain@bridgesofhope.net (682) 704-2601

Congratulations!  You have just taken the first step towards change and healing.  Whatever the reason may be that you are here, I am happy to join you in your journey.  Please take the time to thoroughly read and understand the following important information so that we may have a mutual understanding from the outset of our relationship.  Please let me know if you have questions or concerns. 

CLIENT/THERAPIST RELATIONSHIP:  You and your therapist have a professional relationship existing exclusively for therapeutic treatment. This relationship functions most effectively when it remains strictly professional and involves only the therapeutic aspect. For the same professional reason, your therapist will decline any type of association through social media and can best serve your needs by focusing solely on therapy and avoiding any type of social or business relationship. Gifts are not appropriate, nor is any sort of trade or barter for services.   

AVAILABLE SERVICES:  I offer a wide array of counseling services, including individual, family, couples, and group services. Effective counseling is founded on a mutual understanding and good rapport between client and therapist. It is my intent to convey the policies and procedures used in my practice, and I will be pleased to discuss any questions or concerns you may have.   

RISKS AND BENEFITS: Counseling and psychotherapy are beneficial, but as with any treatment, there are inherent risks. During counseling, you will have discussions about personal issues which may bring to the surface uncomfortable emotions such as anger, guilt, and sadness. The benefits of counseling can far outweigh any discomfort encountered during the process, however. Some of the possible benefits are improved personal relationships, reduced feelings of emotional distress, and specific problem solving. I cannot guarantee these benefits, of course. It is my desire, however, to work with you to attain your personal goals for counseling.  

COUNSELING:  I provide counseling services designed to address many of the issues my clients face. Your first visit will be an assessment session in which we will determine your concerns, and if both agree that I can meet your therapeutic needs, develop a plan of treatment. Should you choose not to follow the plan of treatment provided to you by your therapist, a referral to another provider can be made or services to you may be terminated. 

The goal of Mandy Attaway is to provide the most effective therapeutic experience available to you. Mandy Attaway renders counseling services in a professional manner consistent with accepted ethical standards. If at any time for any reason you are dissatisfied with her services, please discuss this matter with her to determine if transferring to a more suitable therapist is right for you. If you and I decide that other services would be more appropriate, I will assist you in finding a provider to meet your needs.   

Wellness is more than the absence of disease; it is a state of optimal well-being. It goes beyond the curing of illness to achieving health. Through the ongoing integration of our physical, emotional, mental, and spiritual self, each person has the opportunity to create and preserve a whole and happy life. My services are designed to provide my clients an integrated solution for their mind, body, spirit, and life in order to enhance their lives and resolve issues.     

APPOINTMENTS:  Appointments are typically scheduled on a weekly basis and are approximately 50-80 minutes long. More frequent sessions or an intensive outpatient schedule are available if determined appropriate. If you must cancel or reschedule your appointment, I ask that you call my office at (817) 969-4643 at least 24 hours in advance, whenever possible. This will free your appointment time for another client. Appointments cancelled or rescheduled less than 24 hours prior to the start of the session will result in the regular session fee and must be paid prior to rescheduling. 

FEE SCHEDULE:  Sessions are typically 50 minutes long. Together, the client and counselor will make decisions concerning how often and for how long they should meet. Payment of co-pay or session fee is due in full at each session and either cash, personal checks or credit/debit cards are accepted. 

  FEE:  

Diagnostic & Evaluation Session (1st visit) $100.00

Regular Office Visit (50-80 minutes – Individual or Couple) $100.00

Outside Office Work (including but not limited to: $100.00/hour 

inpatient visits, court, collaborative law services)

Written Reports (supervisors, compliance officers, etc)       $100.00/hour

Returned Check Fee  $40.00/per check 

A fee of $25.00 flat rate for up to 25 pages and any additional $1 per page thereafter will be charged for copies of any records requested by the client. Only full files will be provided, no partial files will be provided.
PAYMENT:  Payment of fees is expected at the time of each appointment.  

EMERGENCIES:  If you are experiencing a life-threatening emergency, call 911 or have someone take you to the nearest emergency room for help, or call a suicide hotline: 1-800-SUICIDE. It is the client’s responsibility to seek the appropriate resource in emergency situations. When I am out of town, you will be advised and given the name of another therapist.   

You may encounter a personal, time-sensitive matter which will require prompt attention. In this event, please contact my office regarding the nature and urgency of the circumstances. I will make every attempt to schedule you as soon as possible or to offer other options. Because clients may be scheduled back-to-back, it is not always possible to return a call immediately. However, we will make every effort to respond to this matter in a timely manner. If the situation arises after hours or on a weekend, feel free to leave a message on voicemail for me. I will return your call by the end of the next business day, if not sooner. 

CONFIDENTIALITY:  As a student therapist, I follow all ethical standards prescribed by state and federal law. I am required to practice guidelines and standards of care to keep records of your counseling.  These records are confidential with the exceptions noted below and in the Notice of Privacy Practices available in our office.   

Discussions between a therapist and a client are confidential. No information will be released without the client’s written consent unless mandated by law. Possible exceptions to confidentiality include but are not limited to the following situations: child abuse or neglect; abuse of the elderly or disabled; abuse of patients in mental health facilities; sexual exploitation; criminal prosecutions; child custody cases; suits in which the mental health of the party is in issue; situations where the therapist has a duty to disclose, or where, in the therapist’s judgment, it is necessary to warn or disclose; fee disputes between the therapist and the client; a negligence suit brought by the client against the therapist; or the filing of a complaint with the licensing or certifying board. If you have any questions regarding confidentiality, you should bring them to my attention when we discuss this matter. By signing this Information and Consent Form, you are giving consent to me as a therapist to share confidential information with all persons mandated by law. You are also releasing and holding harmless the undersigned therapist from any departure from your right of confidentiality that may result.   

Bridges of Hope Therapists all work as a team for the benefit of your health and healing. As a team, we may, from time to time, discuss and exchange information with each other about you and your family. In order to provide the best guidance and support to you and your family, as well as, scheduling and payment information. Information exchanges between the members of the team will not be disclosed to other nonaffiliated therapists outside of the practice, unless a written release has been signed by the client.  

When Mandy Attaway works with children and adolescents between the ages of 12-17 years, she uses her professional judgment to ascertain what information will be kept confidential between the child and herself, and what information is appropriate to share with the parents/guardians. Nevertheless, parents/ guardians do have the right to general information, including how therapy is going and dates of services. Keep in mind that the therapeutic process may be more successful if your child(ren) know(s) that his/her/their sessions are going to be, for the most part, confidential. 

When Mandy Attaway works with families, the confidentiality rules become more complicated. In the interest of the therapeutic and healing process, we encourage open disclosure between family members and couples. Mandy Attaway uses a firm no-secrets policy. If a spouse/partner tells the therapist something that may harm the other partner/spouse, or a family member, or may impede the progress of the therapeutic process, the therapist will discuss this with the client, and encourage him/her to disclose it, and cannot promise to keep it confidential. At the beginning of family therapy, those members designated by the therapist and the family will sign a release form to be made part of the therapy record. 

If you and your spouse/partner have a custody dispute, or a custody court hearing is scheduled in the future, Mandy Attaway will need to know about it. Her professional ethics prevent her from conducting therapy and custody evaluations. 

Because discussions between you and your therapist—and even the fact that you are in counseling— are confidential, if Mandy Attaway sees you in public, she will protect your confidentiality by greeting you only if you greet her first. 

DUTY TO WARN/DUTY TO PROTECT:  If my therapist believes that I (or my child if child is the client) am in any physical or emotional danger to myself or another human being, I hereby specifically give consent to my Therapist to contact any person who is in a position to prevent harm to me or another, including, but not limited to, the person in danger.  I also give consent to my therapist to contact the following person(s) in addition to any medical or law enforcement personnel deemed appropriate: 

Name

INCAPACITY OR DEATH:  I understand that, in the event of the death or incapacitation of the undersigned therapist, it will be necessary to assign my case to another therapist and for that therapist to have possession of my treatment records.  By my signature on this form, I hereby consent to another Licensed Mental Health Professional, selected by the undersigned therapist, to take possession of my records and provide me copies at my request, and/or to deliver those records to another therapist of my choosing. 

COMPLAINT PROCEDURES:  If you are dissatisfied with any aspect of our work together, please inform me immediately. If you feel that you have been treated unethically, by me or any other professional in my field, and you are not comfortable resolving the conflict with me, you can contact my Supervisor, Gwen Bain LMFT-S, LPC-S. Gwen Bain’s contact information is listed on the top of the first page. 

CONSENT TO TREATMENT:  By signing this Client Information and Consent Form as the Client or Guardian of said Client, I acknowledge that I have read, understand, and agree to the terms and conditions contained in the Information, and Client Consent form.  I have been given appropriate opportunity to address any questions or request clarification for anything that is unclear to me.  I am voluntarily agreeing to receiving mental health assessment, treatment and services for me (or my child if said child is the client), and I understand that I may stop such treatment or services at any time. NOTE: If you are consenting to treatment of a minor child, if a court order has been entered with respect to the conservatorship of said child, or impacting your rights with respect to consent to the child’s mental health care and treatment, I will not render services to your child until I have received and reviewed a copy of the most recent applicable court order.   

Enter Your Name below to sign this agreement.