Mental Health
This Agreement is intended to provide (herein “Client”) with important information regarding the practices, policies and procedures of Marian Aguwa, LCSW-S (herein “Therapist”) and to clarify the terms of the professional therapeutic relationship between Therapist and Client(s) prior to beginning therapy.
Therapist holds an M.A. in Social Work with an emphasis in Clinical Practices from University of Chicago. Therapist has been working with Clients since 2008 and has worked with a variety of populations including adult, child, and adolescent populations. Therapist has worked with individuals, couples and families.
Therapist has training working with different modalities of couple’s counseling including Gottman Theory, Emotionally Focused Therapy, and Solutions Focused Therapy among others. Which modality is used will depend on the needs of the couple after assessment and will likely use a combination of modalities where appropriate.
Psychotherapy is a process in which Therapist and Client(s) discuss a myriad of issues, events, experiences and memories for the purpose of creating positive change so the relationship might be experiences more functionally and fully. It provides an opportunity to better, and more deeply understand oneself, one’s partner, and the dysfunctional patterns that might be altered in the relationship. Psychotherapy is a joint effort between Client(s) and Therapist. Progress and success may vary depending upon the particular problems or issues being addressed, as well as many other factors.
Participating in therapy may also involve some discomfort, including remembering and discussing unpleasant events, feelings and experiences. The process may evoke strong feelings of sadness, anger, fear, etc. There may be times in which Therapist will challenge Client’s perceptions and assumptions, and offer different perspectives. Therapy does not in any way guarantee that a couple will remain together. In fact, therapy may illuminate for members of the couple that the best course of action is to separate. In such cases therapy can offer the opportunity for that separation to be amicable and functional. Client(s) should be aware that any decision on the status of his/her personal relationships is the responsibility of Client(s).
Telehealth allows your Therapist to address both the physiological and psychological needs of the Client(s) via videoconferencing, email, telephone or smartphone applications. Telehealth services are following a digital evolution by offering behavior health providers an opportunity to continue care for individuals in conjunction with the intimacy and privacy of their own home. As one of the most up-to-date options for therapy, they combat the discomfort of face to face waiting rooms and provide a brave safe remotely.
Professional consultation is an important component of a healthy psychotherapy practice. As such, Therapist regularly participates in clinical, ethical, and legal consultation with appropriate professionals. During such consultations, Therapist will not reveal any personally identifying information regarding Client(s).
Therapist may take notes during session, and will also produce other notes and records regarding Client’s treatment. These notes constitute Therapist’s clinical and business records, which by law, Therapist is required to maintain. Such records are the sole property of Therapist. Therapist will not alter his/her normal record keeping process at the request of any Client(s). Should Client(s) request a copy of Therapist’s records, such a request must be made in writing. Therapist reserves the right, under law, to provide Client(s) with a treatment summary in lieu of actual records. Therapist also reserves the right to refuse to produce a copy of the record under certain circumstances, but may, as requested, provide a copy of the record to another treating health care provider. Therapist will maintain Client’s records for ten years following termination of therapy. However, after ten years, Client’s records will be destroyed in a manner that preserves Client’s confidentiality.
The information disclosed by Client(s) is generally confidential and will not be released to any third party without written authorization from Client(s), except where required or permitted by law. Exceptions to confidentiality, include, but are not limited to, reporting child, elder and dependent adult abuse, when a Client(s) makes a serious threat of violence towards a reasonably identifiable victim, or when a Client(s) is dangerous to him/herself or the person or property of another. Should Therapist be served with a court order for Clients’ records, Therapist will make all efforts to protect Clients’ information, but should the courts demand these records, Therapist is obligated to comply.
Therapist will not voluntarily participate in any litigation, or custody dispute in which Client(s) and another individual, or entity, are parties. Therapist has a policy of not communicating with Client’s attorney and will generally not write or sign letters, reports, declarations, or affidavits to be used in Client’s legal matter. Therapist will generally not provide records or testimony unless compelled to do so. Should Therapist be subpoenaed, or ordered by a court of law, to appear as a witness in an action involving Client(s), Client(s) agrees to reimburse Therapist for any time spent for preparation.
The information disclosed by Client(s), as well as any records created, is subject to the Psychotherapist-Client privilege. The Psychotherapist-Client privilege results from the special relationship between Therapist and Client(s) in the eyes of the law. It is akin to the attorney-client privilege or the Doctor-Client privilege. Typically, the Client(s) is the holder of the Psychotherapist-Client privilege. If Therapist received a subpoena for records, deposition testimony, or testimony in a court of law, Therapist will assert the Psychotherapist. Client(s) privilege on Client’s behalf until instructed, in writing, to do otherwise by Client(s) or Client’s representative. Client(s) should be aware that he/she might be waiving the Psychotherapist-Client privilege if he/she makes his/her mental or emotional state an issue in a legal proceeding. Client(s) should address any concerns he/she might have regarding the Psychotherapist-Client privilege with his/her attorney.
It is often useful to audio and/or videotape sessions both to ensure that Therapist is able to discover additional nuances of the session and for consultation purposes. Moreover, in some cases, such recordings might aid in the therapeutic process itself by allowing Clients to audit behaviors, tones, and information that they otherwise would be unaware of. Client(s) reserves the right at any time to refuse audio and/or video recording during any and all sessions. In such cases where Client(s) prefer/s not to be recorded, Client(s) should request this at the beginning of the session. Of course, should Client(s) decide after the session has begun, Client(s) still reserves the right to subsequently end the recording of the session. In any case, all recordings will be confidential as with any written records per the Confidentiality clause above. Recordings will be kept in password protected format and will be destroyed once the usefulness of the recording has expired (in general approximately 1 to 3weeks).
The usual and customary fee for service is $120 for a 30-minute session and $150 for a 60-minute session. Fee for the Initial Visit is $250. Sessions over already prior schedule are charged for the additional time pro rate. Therapist reserves the right to periodically adjust this fee. Client(s) will be notified of any fee adjustment in advance. From time-to-time, Therapist may engage in telephone contact with Client(s) for purposes other than scheduling sessions. Client(s) is responsible for payment of the agreed upon fee (on a pro rata basis) for any telephone calls longer than ten minutes. In addition, from time-to-time, Therapist may engage in telephone contact with third parties at Client’s request and with Client’s advance written authorization. Client(s) is responsible for payment of the agreed upon fee (on a pro rata basis) for any telephone calls longer than ten minutes. Clients are expected to pay for services at the beginning of the session in which services are rendered. Therapist accepts cash payment via several payment panels such as: (Venmo, CashApp, Zelle)
This office utilizes a collection agency for non-payment of accounts. Every effort will be made to contact you for payment prior to your account being assigned to the collection agency. Your name, address, and other information necessary for collection of amounts due will be released to the agency in the case that it is necessary to collect in this manner. While dates of service will need to be released and the type of service, specific information about your visit will remain confidential.
Current accepted insurances: BCBS, Cigna, Medicare, Medicaid. Client should check with his insurance carrier in order to ascertain whether services are, in fact, reimbursable.
Client(s) is responsible for payment of the agreed upon fee for any missed session(s). Client(s) is also responsible for payment of the agreed upon fee for any session(s) for which Client failed to give Therapist at least 24 hours’ notice of cancellation. Cancellation notice should be left on Therapist’s voice mail at (248) 914-2675.
Therapist’s office is equipped with a confidential voice mail system that allows Client(s) to leave a message at any time. Therapist will make every effort to return calls within 24 hours (or by the next business day), but cannot guarantee the calls will be returned immediately. Therapist is unable to provide 24-hour crisis service. In the event that Client(s) is/are feeling unsafe or requires immediate medical or psychiatric assistance, he/she should call 911, or go to the nearest emergency room.
Therapist reserves the right to terminate therapy at his/her discretion. Reasons for termination include, but are not limited to, untimely payment of fees, failure to comply with treatment recommendations, conflicts of interest, failure to participate in therapy, Client(s) needs are outside of Therapist’s scope of competence or practice, or Client(s) is not making adequate progress in therapy. Client(s) has/have the right to terminate therapy at his/her discretion. Upon either party’s decision to terminate therapy, Therapist will generally recommend that Client(s) participate in at least one, or possibly more, termination sessions. These sessions are intended to facilitate a positive termination experience and give both parties an opportunity to reflect on the work that has been done. Therapist will also attempt to ensure a smooth transition to another therapist by offering referrals to Client(s).
Please note that while I use every precaution on my end to safeguard your information and identity, currently texts and emails from info@betternowmentalhealth.com while made from password protected tools, are not currently considered HIPAA compliant. All scheduling texts and information through the personal communication are considered HIPAA compliant from my end, however, individuals having access to your email or phone may see these messages. If you have concerns with me communicating to you with any of the following methods, please let me know.
I would like to receive appointment reminder texts: YesNo
I would like to receive appointment reminder emails: YesNo
My therapist may call me at my home. My home phone number is: (Type N/A-If Not Applicable)
My therapist may call me on my cell phone. My cell phone number is:
My therapist may call me at work. My work phone number is:
My therapist may send me text other than scheduling texts. YesNo
I understand that e-mail made outside of the scheduling and client portals is not a completely private form of communication). initial
(I understand that e-mail made outside of the scheduling and client portals is not a completely private form of communication). initial
In case of emergency, I prefer my therapist contact at
By signing below, (s) acknowledges that he/she has reviewed and fully understands the terms and conditions of this Agreement. Client has discussed such terms and conditions with Therapist, and has had any questions with regard to its terms and conditions answered to Client’s satisfaction. Client agrees to abide by the terms and conditions of this Agreement and consents to participate in psychotherapy with Therapist. Moreover, Client agrees to hold Therapist free and harmless from any claims, demands, or suits for damages from any injury or complications whatsoever, save negligence, that may result from such treatment. I also understand that I am responsible to Therapist for all session charges and other charges as described above.
Electronically Signed No Signature Needed
