Neuhof Psychotherapy & COnsulting, PLLC (NPC)
SERVICES AGREEMENT AND OFFICE PRACTICES for
psychodiagnostic assessment & psychotherapy clients
Welcome to our practice. This document contains important information about our professional services. Please read it carefully and note any questions you may have so that we can discuss them. Your signature at the bottom will represent an agreement between us.
PSYCHOLOGICAL SERVICES
Psychotherapy is a confidential process designed to assist people in addressing a wide range of mental health, developmental, school/vocational and social concerns through the application of psychological methods and within the context of the therapeutic relationship. In our work, it is your psychotherapist’s job to provide you with a safe place in which you may express your innermost thoughts and feelings, gain insight into relationship patterns and areas of stuckness and bolster key life skills. Other goals of psychotherapy are vast and will be tailored to your unique needs. While your psychotherapist will employ an array of methods to assist you in scaling the issues you hope to address, the process is also collaborative.
Psychotherapy entails sharing information that is often sensitive or private in nature, and it can require a good amount of emotional and mental work on your part. Reactions to the process vary widely—ranging from hesitation, anxiety, frustration and sadness to a sense of greater clarity, calm, stability, vitality, happiness and enthusiasm. All of these reactions can be normal and growth-promoting. If, however, you are concerned about something you are experiencing, please let me know promptly so that we can address it together. While the majority of people who engage in treatment with me report feeling an improved sense of mental health and wellness, there is no guarantee as to what you will experience. Your questions and feedback about the process are always encouraged.
GETTING STARTED
Our first few sessions will involve an assessment of your mental health and treatment needs. During this time, we can both determine if your psychotherapist can meet your treatment needs and whether you might benefit from adjunctive treatment (e.g., group therapy, medical evaluation, holistic method). By the end of this initial phase, your psychotherapist can offer first impressions of what our work would entail. You may evaluate this information along with your sense of comfort in working with me in deciding whether to continue.
When psychotherapy proper is begun, we will typically schedule 50-minute sessions for individuals and 1-hour for couples or families, at an agreed upon time, with session frequency depending on your/your family’s needs. It is not uncommon for patients to request or for us to recommend more frequent sessions during a stressful time, when issues are more serious or upsetting or when a client wishes to do deeper work. If a child or adolescent is being seen, parent guidance sessions are often advised. Consistency of attendance and timeliness on both our parts is an integral part of therapy and facilitate therapeutic progress.
CANCELLATION POLICY
Your appointment time is reserved exclusively for you. Your psychotherapist requires a minimum of 24 notice of cancellation OR rescheduling request. If you provide less notice than 24 hours, then you will be responsible to pay for the session in full (and no-shows are not a reimbursable service by insurance). An exception can be granted for medical emergencies. Your psychotherapist will make every effort to accommodate rescheduling requests.
For therapy at a once per week frequency, 4 cancelled sessions per calendar year are permitted without charge. Additional cancelled (and not rescheduled) sessions (barring medical emergency) will be billed at the regular session rate. We can provide some additional flexibility for therapies of greater frequency.
PROFESSIONAL FEES AND PAYMENT
Payment for psychodiagnostic assessment and psychotherapy services is due in full upon each session.
Rates for other psychological services (provider/family consultation, letter writing, chart/testing report review, school consultation) may be separately arranged. Generally speaking however, it is the same as your psychotherapy hour and may be billed at a prorated rate, but some services, such as fitness to return to school/IHE evaluations, are billed at a higher rate.
In circumstances of financial hardship that can be verified, we will arrange a temporary fee adjustment or payment plan. You may approach us with such request.
If your account has not been paid for more than 60 days and payment arrangements have not been made, we have the option of using legal means to secure payment. If such action is necessary, we would release the minimum amount of patient information possible and as permitted by law.
INSURANCE REIMBURSEMENT
NPC is an out-of-network provider. Upon your request, we will provide monthly statements to help you access any out-of-network benefits you may have. If you intend to utilize your health benefits to assist with payment, we recommend finding out exactly what/if any behavioral health services are covered from the plan administrator. You should know that most insurance companies require you to authorize me to provide them with a clinical diagnosis and additional information such as treatment plans or summaries or, in very rare cases, copies of the entire record. Though insurance companies claim to keep such information confidential, we have no control over what they do with it.
Please note that insurance companies make it clear that there is no guarantee of benefits provision for their members. You (not your insurance company) are responsible for your psychotherapist/NPC’s fee.
GOOD FAITH ESTIMATES
The Public Health Service Act (commonly called the No Surprises Act/NSA) was enacted to protect the public against unexpected charges from their healthcare providers. This could happen when a portion of their bill was not covered by their insurance, and these out-of-network healthcare services could be unexpectedly burdensome. To fix this, the law requires doctors to provide an estimate of expected charges—a Good Faith Estimate (GFE)—to any clients who either do not have insurance or are not planning to be reimbursed through their insurance benefits.
Qualified client of Neuhof Psychotherapy & Consulting, PLLC are entitled to this Good Faith Estimate. If you are interested in a written estimate of your anticipated treatment duration and cost, please request one from your psychotherapist or the NPC administrator office at anytime. The estimate is based on (1) the information you provide us and (2) our professional opinion on what is needed to assess or treat the mental health issues. The estimated cost is the number of anticipated hours multiplied by the stated fee. Of note: Dr. Neuhof and her team offer both brief and long-term psychotherapy, the duration of which is based on client needs and preferences that may change over the course of treatment.
CONTACTING YOUR PSYCHOTHERAPIST
Your psychotherapist will provide you with their direct cell phone and email, and instructions on the best way to communicate with them. NPC psychotherapists monitor their answering machine daily on weekdays (not on weekends or holidays unless specifically arranged). They will make every effort to return your call/email by the next business day. If they will be unavailable for an extended period of time, they will offer you the name of a colleague who you provide you with services or contact as needed.
If you wish to speak with Dr. Jennifer Neuhof, the practice owner, you may leave her a voice message at 646-595-0777 or email inquiries@drneuhof.com, and she will get back to you. For her clients’ routine scheduling matters, text is best at 646-305-2736. Dr. Neuhof’s work hours are Monday - Thursday 2 pm – 10 pm, Friday 1 pm - 6 pm and some weekends.
Please know that email and text are not confidential or secure mediums; heed caution when communicating with us via email or text. It is advisable to keep such messages to a minimum and delete them from your inbox, sent box and trash bins.
If you are unable to reach your psychotherapist and feel you cannot wait, please call 911 or go to the nearest Psychiatric ER for assistance. You may request that the hospital attending contact us for input about your situation.
The National Suicide Prevention 24-hr Lifeline is also available for your use: 1-800-273-8255. Or call 1-800-LIFENET for more general concerns.
CONFIDENTIALITY
All interactions that transpire as part of the psychotherapy process are strictly confidential as required by law and professional ethics. Protected information includes the patient’s name, session content and clinical records. This information is not shared with anyone without our client’s explicit, written permission.
Although exceptions to confidentiality are rare, the most noteworthy ones are listed below:
If your psychotherapist believes that a client presents a threat of serious bodily harm to themselves or another person
There is disclosure or strong suspicion of physical and/or sexual abuse of neglect of a minor, persons with disability or an elderly person
Court order for release of client records or testimony of client information
For the above matters, we may be legally or ethically obligated to breach confidentiality by involving others (i.e. family member or other mental health professional to provide assistance, to report to child or elderly protection agency, to consult with hospital staff). These situations have rarely occurred in our practice, but if such a situation arises, we will make every effort to discuss it with our client and seek their collaboration before taking action.
Also know that a mental health professional’s code of ethics encourages us to consult periodically with other licensed clinicians in order to provide the best possible clinical care. The consultant is also legally bound by confidentiality.
PARENTS, INFORMED CONSENT & DIVORCE
In most cases, it is advisable for all primary caretakers of a minor to be apprised of the child's participation in psychological services. If there are concerns about abuse or neglect if a parent is made aware of the fact that the child is in treatment or of other clinical information, please raise these issues with your psychotherapist immediately so that we can take the appropriate measures to ensure your child's safety and protect the treatment in a manner deemed most beneficial for the child and family.
If you share legal custody and your divorce decree states that you must inform the other parent of health appointments, please note that our services fall under this auspice, and that you may be in violation of a court order if you fail to inform the other parent of our services with your child. By signing below you are stating that you have the legal right to consent for this child (when applicable). In the case of separation or divorce, any matter brought to our attention by either parent regarding the child may be revealed to the other parent when deemed in the best interest of the child. Matters brought to my attention that are inessential to the child’s welfare may be kept in confidence. Please keep in mind, however, that it may be advisable to bring these matters to the attention of significant others such as attorneys, family physicians or school counselors. This information-sharing will ultimately be at the discretion of the parents unless a significant health and safety or legal matter dictates otherwise.
While parent guidance or participation in dyadic therapy is an integral part of child and adolescent treatment, children and teens often benefit from having a measure of privacy. Please feel free to raise any questions or concerns you may have regarding the relative benefit of your child's privacy versus your desire or need to know certain information about their treatment.
I, ___________________________________________________, having fully understood what I just read, and offer my consent for psychotherapy in agreement with the above terms and free of any pressure to do so.
_________________________________________________ Date: ___________
Client Signature (adults consent, minor’s assent)
_________________________________________________ Date: ___________
Parent Signature for Minors