Ranges of psychological services are offered in this practice. I will recommend the services which seem to best address the problems about which you are seeking assistance. Psychotherapy is not easily described in general statements. There are many different methods used to deal with the problems that you hope to address. Psychotherapy calls for a very active effort on your part. In order for the therapy to be most successful, you will have to work on things we talk about both during our sessions and at home.


Psychotherapy can have benefits and challenges. Since therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness, among others. However, psychotherapy also offers countless benefits for people who go through it. Therapy often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress.


Our first few sessions will involve an evaluation of your needs. By the end of the evaluation, I will be able to offer some first impressions of what the work will include and a treatment plan to follow, if you decide to continue with therapy. You should evaluate this information along with your own opinions of whether you feel comfortable working with me. Therapy involves a large commitment of time, money, and energy; so you should be very careful about the therapist you select. If you have questions about any procedures, we should discuss them whenever they arise. If your doubts persist, I will be happy to help you set up a meeting with another mental health professional for a second opinion.


Most evaluations take from 2 to 4 sessions. During this time, we can both decide if I am the best person to provide the services you need in order to meet your treatment goals. If psychological services are initiated, I will usually schedule appointments with a recommended duration and frequency. 



My hourly fee is $140. In addition to weekly appointments, I charge this amount for other professional services you may need, though I will break down the hourly cost if I work for periods of less than one hour. Other services include report writing, telephone conversations lasting longer than 10 minutes, attendance at meetings with other professionals you have authorized, preparation of records or treatment summaries, and the time spent performing any other service you may request of me.   If you become involved in legal proceedings that require my participation, you will be expected to pay for my professional services. Because of the difficulty of legal involvement, my fees for legal services are different, and will be quoted at the time you request the service, based on the services required.



Payment is requested at or before the time services are rendered. If expensive or extensive treatment is anticipated, arrangements may be made for a payment plan. The client (or legal guardian in the case of a minor) is responsible for all fees, regardless of insurance carrier. If a person other than the client, client’s spouse or parent has accepted financial responsibility for medical bills, a signed consent to that effect must be on file. Any remaining balance on accounts is payable within thirty days of the date when service is rendered. Finance charges will be applied at the rate of 1.5% per month to balances over thirty days old. If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, I have the option of using legal means to secure the payment. This may involve hiring a collection agency or going through small claims court. If such legal action is necessary, its costs will be included in the claim. In most collection situations, the only information I release regarding a client’s treatment is his/her name, the nature of services provided, and the amount due.



In order for us to set realistic treatment goals and priorities, it is important to evaluate what resources you have available to pay for your treatment. If you have a private health insurance policy, it may or may not provide coverage for mental health treatment. You should carefully read the section in your insurance coverage booklet that describes mental health services. If you have questions about the coverage, call your plan administrator.  I am happy to provide you with whatever information I can and will help you in understanding the information you receive from your insurance company. It is important for you to call to preauthorize any mental health care with the insurance company. If the case involves you or your children’s difficulties in school, please be aware that most insurance plans do not consider educational evaluations to be “medically necessary.” Therefore, most insurance plans do not provide coverage for testing regarding academic or educational issues. Most importantly, as I am still in the process of gaining full licensure with the Texas State Board of Examiners of Psychologists and therefore require supervision as described above, some insurance carriers will not approve our sessions at this time. That said, many clients have benefited from full reimbursement from their providers. If you would like to pursue claiming insurance reimbursements  in the future, please let me know and I will inform you as the status of my licensure progresses.



While I am usually in my office between 9 AM and 5 PM, I do not answer the phone when I am with a client. When I am unavailable, you may leave a voicemail or send me an email which I check multiple times each day. I will make every effort to return your call within 24 hours, with the exception of weekends and holidays. If you are difficult to reach, please inform me of some times when you will be available. If you are unable to reach me and feel that you can’t wait for me to return your call, contact your general physician or the nearest emergency room and ask for the psychologist on call. If I will be unavailable for an extended time, I will notify you in advance.



The laws and standards of my profession require that I keep treatment records. You are entitled to receive a copy of your records, or I can prepare a summary for you. Because these are professional records, they can often be misinterpreted and/or upsetting to untrained readers. If you wish to see your records, I recommend that you review them in my presence so that we can discuss and articulate their contents. Clients will be charged an appropriate fee for any professional time spent in responding to information requests.



If you are under eighteen years of age, please be aware that the law may provide your parents the right to examine your treatment records. If your parents agree, I will provide them only with general information about our work together, unless I feel there is a high risk that you will seriously harm yourself or someone else. In this case, I will notify them of my concern. I will also provide them with a summary of your treatment when it is complete. However, before giving them any information, I will discuss the matter with you, if possible, and do my best to handle any objections you may have with what I am prepared to discuss.

 In the case of minors whose parents are actively involved in litigation regarding the minor, the law may require that an attorney be appointed to represent the child in deciding whether privilege should be waived and records should be released. In these special circumstances, these issues will be discussed with the parents and whoever is responsible for the privileged communication of protection of the minor.



In general, law protects the privacy of all communications between a client and a psychologist, and I can only release information about our work to others with your written permission. But there are a few exceptions.

 In most legal proceedings, you have the right to prevent me from providing any information about your treatment. In some proceedings involving child custody and those in which your emotional condition is an important issue, a judge may order my testimony if he/she determines that the issues demand it.

 There are some situations in which I am legally obligated to take action to protect others from harm, even if I have to reveal some information about a client’s treatment. For example, if I believe that a child or vulnerable person is being abused, I am required by law to file a report with the appropriate government agency.

In addition, if I believe that a client is threatening serious bodily harm to another, I am required to take protective actions. These actions may include notifying the potential victim, contacting the police, or seeking hospitalization for the client. If the client threatens to harm himself/herself, I may be obligated to seek hospitalization for him/her or to contact family members or others who can help provide protection. These situations have rarely occurred in my practice, however, if a similar situation occurs, I will make every effort to fully discuss it with you before taking any action.

 Until the time that I gain full licensure as a Psychologist with the Texas State Board of Examiners of Psychologists, part of my requirements are to have my cases supervised by a Psychologist Licensed in the state.  This role will be fulfilled by Dr. Chrystina Bacek.  If you have any concerns regarding my practice, you are welcome to contact her directly, or contact the Texas State Board of Examiners of Psychologists, both whose contact information is provided at the bottom of this form. Additionally, I may sometimes find it helpful to consult other professionals about a case During supervision or a consultation, I make every effort to avoid revealing the identity of my client. The supervisor and any consultant is also legally bound to keep the information confidential. If you don’t object, I will not tell you about these discussions unless I feel that it is important to our work together.

 While this written summary of exceptions to confidentiality should prove helpful in informing you about potential problems, it is important that we discuss any questions or concerns that you may have at our next meeting. I will be happy to discuss these issues with you if you need specific advice, but formal legal advice may be needed because the laws governing confidentiality are quite complex, and I am not an attorney.