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Please read the following
information carefully. It is your responsibility to understand the
conditions of establishing a counseling agreement prior to entering into the
counseling relationship. Continuing into the counseling relationship, is
considered your acceptance and understanding of these terms. Should you
have any questions concerning this agreement, please call or e-mail my
office.
Pamela Milam, MA, LPC, is established as an individual in private counseling
practice in the city of Dallas, Texas. Primary ethical responsibilities and
obligations are to the Licensed Professional Counselor's Board of the
Department of Health in the State of Texas. Ethical responsibilities are
also recognized through membership in the ACA. For purposes of this
agreement, Pamela Milam, MA, LPC will be referred to as "counselor" and the
individual seeking counseling services will be referred to as "client".
All clients engaging in any form of counseling relationship, must be 18
years of age or older, unless accompanied by a parent during the initial
meeting.
Privacy & Confidentiality:
All communications are conducted in a private setting and held in strict
confidence. Information shared can not be released by the counselor to
anyone except for the follow exceptions: (1) A client reveals the thoughts
or plans to harm themselves or others. (2) Reveals any situation that may be
considered abuse or danger to a child or elderly individual. (3) Any legal
issues involving the client that results in demand for information as per a
court order, (4) With clients written consent.
Security of Telephone Counseling:
The telephone will be used to collect personal information, should the
client not wish to disclose this through e-mail. Telephone counseling
services are provide utilizing standard telephone equipment and services.
Client agrees to provide counselor with the telephone number they wish to
utilize for this service. The call will be made at the scheduled session
time. Client holds responsibility for establishing a comfortable
environment for themselves, without risk of interruptions or distractions.
Client is also asked to disengage telephone features such as call waiting
and call block for the session time.
Limitations Of Services:
 | Online and Telephone Counseling may not be the most appropriate modes
of counseling services for certain situations or
individual issues. |
| Clients in an emergency situation or crisis, and/or experiencing
thoughts of suicide, self harm or harming others, must call 911
immediately. |
| Clients with situations involving serious mental health issues
requiring intense psychotherapy must seek an individual office counseling
session. |
| Before entering into a counseling relationship, client agrees to a
brief evaluation of needs, and will enter into the agreed mode of
counseling services at their own risk.
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Evaluation for Services:
Prior to setting an appointment, each client must provide as much
information as possible, so counselor may briefly evaluate clients needs.
This can be done by telephone or e-mail. The purpose is to establish the
client's needs and appropriate mode of services. There is no charge for
this exchange of information.
Fee Agreement:
Fees are to be paid prior to services provided. (1) Checks or cash or
credit card may be used as payment for office visits. Credit card
payments must be made utilizing the "Online Payment" option in this web
site. (2) Credit card may be used for online counseling services by also
utilizing the Online Payment option.
Insurance Provider:
The client is asked to self-pay and file with his/her insurance company
for reimbursement. Responsibility for payment rests with the client.
Missed or Canceled Appointments:
Client agrees to cancel appointments at least 24 hours in advance.
Clients not giving proper cancellation notice, will be charged a $50.00
fee for each missed appointment.
Fee Refunds:
Refunds will be given for the following reasons:
| Client gives at least 24 hours notice to cancel prepaid appointment.
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| Counselor fails to keep the appointment. |
| All refunds will be made by money order, mailed to client within seven
days. Due to the security of the credit card payment program,
counselor cannot access your card information for a refund to your
card. |
Equipment Failure:
One of the disadvantages of utilizing telephone and computer/Internet
technology is the unforeseen equipment failure. Should client or
counselor lose connection during an online session, both will attempt to
reconnect immediately. No charges are accrued during this reconnect
time. Should reconnection not be immediately possible, the time remaining
for your session will be credited to another session time. Counselor does
not accept responsibility for any technical difficulties that could
occur. Should technical failure prohibit an online session, alternative
arrangements or another scheduled session will be made.
Payment Utilizing Online Payment Option:
Online payment for credit card use is very simple. Client clicks the
Paypal's icon on the Online Payment page of this web site and follow the
directions. Online payment is provided through "PayPal", an online
payment company. If client has not used this service in the past, they
will be asked to complete a one time information form. Counselor does
not have access to this information. When client makes payment, the
counselor is notified by e-mail of receipt of the payment. Counselor
contacts client with confirmation of payment and arrangements for
scheduled session time. Paypal reports their sites and service to be
secured. Please read their agreement carefully. Client accepts full
responsibility of choosing the use of "Paypal". Counselor is not
responsible for any actions, errors, or failures made by "Paypal". Any
questions concerning the Paypal system may be directed to Paypal.com.
Referrals for Additional Services:
Occasionally the client may need additional services not offered by
counselor. Counselor will provide client with referrals if possible.
However, client holds the responsibility and risk for contacting and
accepting these services and their outcomes.
Termination of Services:
Client or counselor may choose to terminate the counseling relationship at
any time. The party choosing to terminate the relationship, agrees to
contact the other party through e-mail or written letter, with reasons
for termination. Client may choose to terminate the counseling
relationship at anytime. Counselor may terminate relationship if they
feel the client has reached their goals, the client is not progressing
under the counselors care, or the counselor is not qualified to provide
the services needed at this time. Counselor agrees to provide client with
referrals for more appropriate services should this be needed.
By making arrangements to use the counselor’s services, you are agreeing
to all conditions stated in this policy.
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