Please read the following letter which explains our practice policies.

Anger & Stress Management Center, Inc.

10375 B Democracy Lane

Fairfax, VA 22030

                                                                                                                                                                             January 1, 2017 

Dear Client:

     Welcome to the Anger & Stress Management Center, Inc. I appreciate your having selected me to provide services and will do all I can to offer the highest quality care possible.

     This letter tells you about my office practices and provides information about privacy practices. Please read it carefully and be sure to let me know of any questions or concerns you might have or needs or matters which have not been addressed. I ask that you sign the Intake Form below to indicate you understand and agree to follow these office procedures.

Services

     Therapy sessions are scheduled for a forty-five to fifty-minute period unless otherwise specified. We begin and end the sessions at the appointed times. If I am late starting, you will receive your allotted time. If you are late, we will still end at the originally scheduled time.

Cancellations

     It is important that you notify me as soon as possible if you will be unable to keep your appointment since that time is reserved just for you. If you cancel a full 24 hours in advance you will not be charged. You will be charged the full session fee for appointments not canceled a full 24 hours prior to the meeting time unless I am able to fill the appointment. Most insurance companies do not reimburse for missed appointments.

Payment

     Payment by cash or check is due when services are rendered. The fee is $75 for a 45 to 50 minute session. If you have insurance, I will provide any required documentation or receipts. I ask that you pay at the time of service and have insurance reimbursement sent directly to you. This policy allows me to keep expenses lower and pass savings on to you. Also, if you are paying by check, please have the check written before the session starts to preserve the entire session time for therapy. A 5% late fee will be charged for every 30 days a payment is late, and a $25 fee will be assessed for any returned checks.

Confidentiality

     The service you receive is confidential and no information will be released to a third party except at your written authorization. The law mandates exceptions to this policy if an individual reveals a threat of danger to self or to someone else, or discloses abuse to a child under the age of eighteen or to an aged or incapacitated adult, or in response to a court order or subpoena. Also, I do consult with colleagues for up to date treatment information and direction, and guarantee confidentiality in this process.

     Insurance or managed care companies require appointment dates, charges and a diagnosis. Some may require more detailed information such as treatment plans, progress notes or more specific reports regarding symptoms as a condition of coverage. You have the right to ask your insurance carrier what information you are consenting to be released about your treatment in order to be reimbursed.

    Please see the Notice of Privacy Practices (Effective April 14, 2003).

Communication

     Please leave messages on our phone mail system, 703-293-9231 ext 4, anytime day or night. I will respond as soon as I can, usually within the hours of 9 a.m. to 6 p.m., Monday through Thursday. If you have caller ID and block anonymous calls, my return call to you might be delayed until I can place it directly from my office (usually Tuesday through Thursdays) unless you remove the block by pressing *87. Since phone discussions are generally not as efficient or effective as face to face meetings, I ask that you please schedule an appointment if you think you will need more than five minutes to resolve an issue by phone.

     If you are calling with a mental health emergency, i.e., a situation that requires fast resolution for your safety or welfare, please call the emergency number provided in my voicemail greeting, and leave a message and phone number there. I will return your call as quickly as possible, usually within 60 minutes. If for any reason, I fail to call back in a timely manner or you cannot safely wait, please go to your nearest hospital emergency room or call your nearest mental health center.

     If on the rare occasion that you need to make frequent calls and or the calls repeatedly last longer than five minutes, I will advise you of the charges for extended phone consultations.

Legal Services

     If for any reason you intend to request my participation in pending legal proceedings (e.g., court appearances or participation in a deposition), please notify me and obtain a schedule of fees for legal services. There is no extra charge for letters to courts, attorneys, employers or other third parties confirming that you have participated in treatment.

Professional Licenses and Certifications

     I have a Master’s Degree in Psychological Services and am a Licensed Professional Counselor and a Licensed Marriage and Family Therapist in the Commonwealth of Virginia, and a National Certified Counselor.

Other Concerns

     Please let me know if there is anything I can do to improve my services.

Note

     While Loretta Rowe of the Anger and Stress Management Center, Inc. and Margaret Cirillo of Associates in Counseling and Education, Inc. share office space and market services together, each is a separate legal entity and assumes and assigns no legal responsibility for the other. Similarly, any other therapists sharing these premises are separate legal entities and Loretta Rowe and Margaret Cirillo assume and accept no legal responsibility for their practices.

                                                                                                                                         Sincerely,

                                                                                                                                         Loretta G. Rowe