Please print the appropriate registration AND questionnaire packets above, read all policies included, and bring with you to your first appointment.
We will review your paperwork together.

Below are summaries of our individual office policies for your reference:

Financial Policy (insurance)

Some or all of the appointment fee may be covered by insurance. However, insurance often requires copayment (set amount), coinsurance (percent), or deductible amounts. It is your responsibility to verify the specifics of your coverage. You also have the option to self-pay if you prefer to opt out of utilizing insurance coverage or have no insurance coverage. We require a credit card to be kept on file for payment of costs not covered by insurance. Payment can also be check or cash at the time of service.

Financial Policy/Good Faith Estimate (private-pay)

You will be completely responsible for any and all costs associated for services provided and will pay for services directly. Under the law, patients who don’t have insurance or who aren’t using insurance, have the right to receive a “good faith estimate” of treatment costs. For therapy, the estimate is straight-forward: the standard fee for self-payment is $100 for one-hour session and $75 for 45-minute session due at the time of service. We require a credit card to be kept on file; payment can also be check or cash at the time of service.
Note: Self-pay rates are less than what is billed to insurance to reflect the eliminated time and cost associated with insurance billing and accounting.

Cancelled Appointments

Appointments missed without canceling will require a $50 fee. Cancellations with less than 48 hours notice may require a $50 fee unless rescheduled within the week. When therapy becomes difficult it can be easy to avoid attending sessions; talk about these feelings with your provider.

Privacy Policy

As a therapy client, you have privileged communication with your provider. All information shared in sessions and any written records are confidential and may not be released without written consent or when the law requires. The law requires disclosure of confidential information in cases of suspected child or elder abuse/neglect and when a client presents a serious risk to self or others. Your provider will inform you if information must be shared and will explore all other options with you before the step is taken.

Social Media Policy 

Friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc.) may compromise your confidentiality and blur the boundaries of therapy and will not be accepted by your provider. Email and text communication are not completely confidential. Please notify your provider at the beginning of treatment if you would like to avoid these forms of communication.

Emergency/Crisis Policy

Because Soul & Psyche is a limited practice, there is no 24-hour emergency or “on call” coverage. If a crisis or emergency (such as new or worsening thoughts of self or other-directed harm) arises, you may leave a phone message for your provider but do not wait for your provider to call you back. Instead, do one of these things:

·        Dial 911 or go to the nearest emergency room

·        Call or go to Lifeways Community Mental Health Center (1200 N. West Ave. Jackson, 517-789-1200)

·        Call or go to Henry Ford Allegiance Access Center (Anderson Bldg at HF Allegiance Hospital, 517-205-5971)