George R. Warsaw, Ph.D., LLC Sandy Springs, GA 30328 404-256-0244
Treatment Contract
Informed Consent and Administrative Policies
Welcome. The following information is meant to inform you about our policies and understanding of our professional relationship. Psychotherapy is a relationship that requires open communication. If you have any questions about these or any other aspects of your treatment, please feel free to bring them up at any time.
Our Professional Relationship: I believe that all individuals have the capacity to thrive. It is a privilege to work with you in helping you do so. It is impossible to guarantee specific results regarding therapy. However, we will work together to achieve the best possible results for you. It is essential that you are actively involved in setting your goals.
Payment for Services: We accept cash, checks, major credit cards and Venmo.
Cancellations: If you cannot keep your appointment time, please give us at least 24 hours’ notice or cancel by noon on Friday for Monday appointments so that we can make the time available for others. If you cancel with less notice or miss a scheduled appointment, you will be charged for the appointment.
Confidentiality & Exceptions: Confidentiality is an essential part of the therapeutic process and is a commitment that is made to you. Consistent also with the mental health laws of Georgia, no information about you will be released without your written consent. There are specific exceptions to the commitment of confidentiality:
When it is believed that you are a threat to your own or someone else's safety.
When a minor child is endangered by abuse or neglect.
When a court issues a subpoena for your records.
In each of these instances, we will make every effort to speak with you before communicating with anyone else.
If you are seeing another healthcare provider, it may at times be necessary to exchange information regarding your treatment. In those cases, you will be asked to complete an authorization to release information.
Please review the Notice of Privacy Practices available in the reception area when you arrive for your first appointment. It describes in more detail your rights with regard to Protected Health Information.
Records Release: To have records released to another provider, it is necessary first to sign a "Release of Information form" and make payment of $65.
Communication and Emergency Contact: We do our best to return phone calls as soon as possible; however, occasionally there are unavoidable delays.
Calls received after 5 p.m. and on the weekends will be returned the next business day. In case of emergencies, dial 911.
Client Signature: Your signature indicates that you have reviewed and understand this document and agree to adhere to the policies.
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