Informed Consent for Psychotherapy

The purpose of this notice is to provide you with information regarding the psychotherapy services that Mental Health Services of Maryland, LLC offers, and to obtain your informed consent to participate in therapy. Please take the time to read this document carefully and feel free to ask any questions you may have before making a decision.

Nature and Purpose of Psychotherapy:

Psychotherapy is a collaborative process in which we will work together to explore and address concerns you may be experiencing. The goal is to help you gain insight, develop coping skills, and make positive changes in your life. It is important to note that therapy outcomes vary, and there are no guarantees of specific results.

Confidentiality:

Your privacy is of utmost importance, and all information disclosed during our sessions will be kept confidential, except in the following circumstances:

If there is a risk of harm to yourself or others.

If there is suspected child or elder abuse.

If you disclose information about a plan to commit a crime.

If a court subpoenas your records.

I will discuss any necessary disclosures with you before taking any action. Additionally, in certain therapeutic situations, I may consult with colleagues or supervisors to ensure the quality of my services.

Treatment Plan:

We will collaboratively develop a treatment plan that outlines your therapeutic goals and the methods we will use to achieve them. This plan will be reviewed periodically and adjusted as needed.

Fees and Billing:

Fees for services will be discussed and agreed upon before starting therapy. Payment is expected at each session unless other arrangements have been made. At Mental Health Services of Maryland we accept credit card payments and Flexible Spending Accounts (FSA) can be used to pay for psychotherapy.

Cancellation Policy:

I understand that unforeseen circumstances may arise, requiring you to cancel or reschedule appointments. Please provide at least 24 hours' notice for cancellations. Missed appointments without notice may be subject to a cancellation fee.

Limits of Confidentiality in Telehealth:

If we engage in telehealth (video or phone) sessions, please be aware that there are potential risks to privacy and confidentiality. It is your responsibility to ensure a secure and private environment during our virtual sessions.

Rights and Responsibilities:

You have the right to ask questions, express concerns, and terminate therapy at any time. I will strive to provide a safe and supportive environment, and I encourage open communication about your experience in therapy.

  
 
 By signing below, you indicate that you have read and understood the information provided in this Informed Consent for Psychotherapy, and you consent to participate in therapy under the terms outlined.

Full Name

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Date:

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If you have any questions or concerns, please do not hesitate to reach out.