Forms
Please print and fill out the forms below and bring them to your first appointment.
- CIH Medical Office Registration Form
- CIH Credit Card Authorization
- CIH Service Contract
- CIH Privacy Statement
- CIH Privacy Signature Sheet
Policies
APPOINTMENTS
Initial appointments are focused on gaining an understanding of the difficulties that are bringing you into therapy. Our therapists will listen carefully to your issues and will usually ask follow up questions to create an initial idea of how to be helpful to you. It is not uncommon to need several sessions to gain a clear understanding of all the issues involved, and by the end of this assessment period both you and the therapist should have a good definition of the problems and a therapeutic treatment plan to address them. Appointments are usually scheduled on the hour and last 50 minutes, generally. Appointments can be scheduled with your therapist or at the front desk, or you may use the SCHEDULE link on our website.
BILLING/PAYMENTS
We are dedicated to providing excellent, standard-of-care, therapy services to a wide range of people. We accept many insurance plans and will directly bill your insurance company. We also accept fee-for-service clients for those who want excellent service, but do not have an insurance provider in our network. Your copay or full fee is expected at the time services are rendered.
CONTACTING YOUR THERAPIST/EMERGENCIES
Please feel free to contact the office during normal business hours, or leave a voicemail message at any other hour if you need to get in touch with your therapist. He/she will make every effort to return your call by the end of the next business day. Generally, your therapist is not available after regular business hours, so if you have an emergency, Frederick Memorial Hospital Emergency Room is a 24-hour resource, or you can call 911. The confidentiality of your contract with your therapist, and this office, will be respectfully and professionally maintained.
CONFIDENTIALITY
In general, the privacy of all communications between a patient and a therapist is protected by law, and we can only release information about our work to others with your written permission. In the case of family, group, or couples counseling, ALL participants must provide written consent in order for any information to be released. One family member, marital partner, or group member may not waive privilege for any other. There are, however, a few exceptions. In most legal proceedings, you have the right to prevent me from providing any information about your treatment. In some proceedings, such as those involving child custody and/or those in which your emotional condition is of concern, a judge may order the testimony of a therapist. There are some situations in which the therapist is legally obligated to take action to protect others from harm, even if the therapist has to reveal some information about a patient’s treatment. For example, if the therapist believes that a child, elderly person, or disabled person is being or has been abused or neglected, the therapist must file a report with the appropriate state agency. If the therapist believes that a patient is threatening serious bodily harm to another, the therapist is required to take protective actions. These actions may include notifying the potential victim, contacting the police, and/or seeking hospitalization for the patient. If the patient threatens to harm himself/herself, the therapist may be obligated to seek hospitalization for him/her or to contact family members or others who can help provide protection.
For a full list of our terms and policies, please click here. We ask that you please print out, sign and date the services contract and bring it with you to your first appointment. We also request that you print, sign and date our Notice of Privacy Practices sheet which can be found here.