Office Policies, HIPAA Notice, & Informed Consent

NOTE: If you are ready to become a Forward Motion client, then read this carefully. When you complete the intake form, you will be asked to attest to the fact that you read and understand these policies. Your attestation serves as your informed consent to receive services. 

Office Policies, HIPAA Notice, & Informed Consent

Services. I provide out-patient mental health services. These include assessment and treatment of individuals, couples, or families. I determine if any condition or symptoms are beyond my scope or capacity and make referrals accordingly. I do my best to respond as positively and constructively as possible to what each client asks my help to address.

Appointments. Psychotherapy and counseling appointments might vary in length from 30 to 60 minutes but average 45 minutes to best meet your needs. Fees are set by time spent. Your appointment time is held exclusively for you. If you realize you can’t make your appointment, we ask that you provide at least 24 hours’ notice, or you may be charged for that time. Insurance does not pay for missed appointments.

Office Hours and Client Emergencies. I provide services by appointment only. I do my best to quickly respond to voicemail, email, and text; my goal is to respond within 24 hours. In case of an emergency, please call 911 or go to the nearest hospital emergency department. When I take a break from my practice, I will have arranged for call coverage.

Confidentiality and the Release of Information. All information about you is confidential and will not be disclosed without your written consent except for coordination of medical care. However, I am legally and ethically bound to properly report if 1) I suspect abuse or neglect of a child or elderly person, 2) I believe the client presents a clear and imminent danger to him/herself or to another person, 3) a properly executed court subpoena requires me to testify or provide my records, or 4) an insurance company is helping to pay the fee and requires information about diagnosis and/or reports about treatment. Please note that regular email and texting are not considered secure and may not be confidential. I use secure email and texting for my client’s protection and convenience (more information below).

HIPAA Notice of Policies and Practices. Mental health providers are required by Federal law (Health Insurance Portability and Accountability Act or HIPAA) to protect the privacy of your personal information and to give you a notice that describes (1) how clinical information about you may be used and disclosed and (2) how you can get access to this information. I am obliged to share information as needed to coordinate care with your other healthcare providers. I use electronic devises and internet services to manage protected health information. I ensure that these devices and services are secure to comply with HIPAA.

Fees and Billing. Initial evaluation and therapy appointment fees may depend on your insurance carrier and other factors. We file claims to most third-party payers. Online audio/video visits require a credit/debit/HSA account number kept on file by the Stripe processing service. Unless specifically arranged, out-of-pocket obligations for these visits are collected automatically at the end of each one. Otherwise, we accept cash, check, or card payments for out-of-pocket obligations. We can send electronic invoices for you to pay by card or check. Should you need to delay your payment, we bill monthly on the 25th of the month. When you receive an invoice, you are expected to make payment no later than the 25th of the next month.

Health Insurance. Your insurance coverage is a contract between you and your carrier. Most carriers have a contract with me that reduces costs. Any portion of fees not covered is your responsibility. As a courtesy, we file insurance benefit claims and will follow up with them to assist in getting reimbursement for services. However, you are responsible to learn and understand what your insurance covers, optimally before you begin treatment and to track this coverage as treatment progresses. You are responsible for the entire bill whether the insurance pays or not. Your portion is due at the time of services unless arrangements have been made in advance with our office.

Information about Insurance Billing. Please make a point to understand how your insurance works. If you have a deductible to pay down and we bill your insurance, then you must pay us in full until your deductible is met. If we are contracted with your insurance provider, you will not be charged more than our contracted rate with your carrier. You are responsible for your co-pay or for any deductible plus coinsurance. If you wish to file your own claims, we ask that you pay at the time of service. We provide statements as receipt of payment that includes the information you need to file your claims.

If you provide us with health insurance information, you agree to the following: You authorize the release of any health information necessary to process insurance claims for services provided. You authorize your insurance company to pay medical benefits to the provider of services. You authorize payment of government benefits either to yourself or to the party who accepts assignment. You understand that you are fully responsible for all professional fees not covered by this assignment. You understand that payment is due in full at the time of service unless prohibited by my contract with your insurer. We ask that you pay at the time of each appointment.

Fillable Forms: My intake forms are accessible through my website. See the “Counseling” page. The online forms have a “submit” button at the end that securely sends your information to me. If you have need to do so, then you can complete as many “Release of Information” forms as you need using your personal computer or smartphone. But, you will need to use Adobe Acrobat Reader DC (free to download at or a similar app. Of course, you can print blank “Release of Information” forms  to complete, scan, and deliver using my website’s “Contact Us” page for secure delivery.

Electronic Communication – Email, Text, and Online Interaction: I strive to ensure that your protected health information (PHI) is private and confidential. Use of email, texting, and interacting online are all vulnerable to eavesdropping unless special programs/applications are used. So, I ask you to use the methods I’ve chosen if you want to use email, texting, or video chat. It is my policy to respond by phone if I receive from you an unsecured email, text, or video chat.

For email, I use Hushmail. If you email me at, your message is not secure unless you use Hushmail too. But when I respond to your email through Hushmail or send you one, then your responses and mine are secured. I can also ensure privacy if you use the “Contact Us” form on my website. You can attach files either way.

For texting, I use Signal. If you want to communicate by text, then I ask you to download the Signal app on Apple or Android and agree to use that app when texting me. The message bubble has a unlocked padlock image to indicate if the message was not sent through Signal. You can attach files too for secure delivery.

For video meetings, I use VSee. It’s possible to have a brief chat on VSee. But it has to be scheduled. I use this service predominantly for counseling sessions. The next section offers more information about that.

Online-Video & Phone Meetings: Therapy sessions can be conducted via online-video or phone. I prefer online video. I use a service called VSee where I have a “virtual clinic”. I meet with individuals, couples, and family groups who use their personal computers, tablets, or smartphones to meet with me across secured electronic communication. It works great start to finish and allows you to be anywhere in Oregon that has a sufficient internet connection available in a reliably private space. Without video, of course we just use a phone. For details on signing up for VSee video visits please see the “Telemental Health” tab on my website.