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:
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Online and Telephone Counseling may not be the most appropriate modes of counseling services for certain situations or individual issues. |
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Clients in an emergency situation or crisis, and/or experiencing thoughts of suicide, self harm or harming others, must call 911 immediately. |
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Clients with situations involving serious mental health issues requiring intense psychotherapy must seek an individual office counseling session. |
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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. |
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:
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Client gives at least 24 hours notice to cancel prepaid appointment. |
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Counselor fails to keep the appointment. |
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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.