POLICIES & PROCEDURES

Welcome to Soul City Therapy, LLC. Since you are new here, we hope that this provides in-depth answers to some of your questions, as you embark on the wonderful journey of therapy. When you sign this document, you are stating that you understand and will adhere to the information in this Informed Consent. If you still have questions, we welcome you to ask for more clarity.

Services Offered

Soul City Therapy, LLC. provides outpatient counseling services. We work with adults and adolescents. Licensed practitioners provide individual, couple, and family counseling out of the South Loop office or via tele-therapy. In extenuating circumstances, another agreed upon location may be used. In the event that you are out of town, sick or need additional support, phone or tele-therapy sessions are available.

We strive to return all messages as quickly as possible, Monday through Friday. Messages left on the weekend may be returned Monday. We do not guarantee 24-hour crisis coverage and if your therapist is not available when you feel you are in crisis, please reference our resource page for crisis numbers, proceed to your local hospital emergency room, or call 911.

Initial Appointment, Diagnosis, and Counseling Process

Initial assessments take place during the first appointment. These appointments are used to learn more about you as a person, some of the challenges that led you to make an appointment, your intended goals, and to determine the best course of care. We ask that you submit the intake forms at least 24 hours before your initial appointment, in order for your therapist to have time to review the documentation.

A diagnosis will be given for each client being seen, just as with a visit to a medical doctor. If ongoing counseling is recommended, and the therapist and client decide to work together, we will diligently work to provide the best therapeutic care possible. Therapist and client will create a treatment plan that addresses both long-term and short-term goals in order to best meet the needs of why the client came in for therapy. Therapy sessions are commonly set for once per week, for approximately 53 minutes.

For the counseling process to be successful, your commitment to the process is essential. This commitment includes regular attendance, active participation, and completion of the process through planned termination of counseling services. Homework may be used between sessions to help enhance your growth process. You may initially begin to find some relief of symptoms, and it may be tempting to terminate. However, this initial relief is often temporary if counseling is stopped abruptly. Because all therapists want to see you have the greatest growth possible during the time you are here, we will work with you to plan a successful wrap-up. This is an important part of the counseling process, and we highly encourage you to honor your own work by not neglecting this phase.

Rates and Insurance

Our current fees are as follows:

Initial Intake Appointment: $150

Individual Therapy Sessions: $125

Couples Therapy Sessions: $125

If you are interested in paying out-of-pocket, we offer therapy packages for individual counseling (including initial appointment) in the following increments:

Initial + 4 sessions: $575

Initial + 8 sessions: $950

Initial + 12 sessions: $1250

We are an in network with Blue Cross & Blue Shield of Illinois PPO (Including: Blue Choice PPO, Blue Choice Preferred PPO, and Blue Options PPO). If you have an insurance that is out-of-network, you can be given a Super-bill for your sessions, which you may use to request reimbursement from your insurance company, and will include a diagnosis. Telephone consults less than 10 minutes are complementary if not overused. Phone sessions that last more than 10 minutes will be charged to the client directly. Phone sessions are the same cost as office sessions.

 

Payment is due at the time of service. Acceptable forms of payment are any major debit or credit card, as payment is required electronically. If fees for services are not paid in a reasonable amount of time, and attempts have been made to resolve the financial matter to no avail, a client account may be sent to a collection service.

Cancelled or Missed Appointments

Due to the nature of counseling services, we never overbook our schedules. We require 24-hours notification of cancellation. We charge a $65 Cancellation Fee for any appointment not cancelled 24-hours in advance. If you are more than 20 minutes late for your scheduled appointment, you may be asked to reschedule for another day and you will be charged the $65 Cancellation Fee. These fees are immediately due by you.

Please note that two or more instances of missed appointments without notifying your therapist may result in termination of services. In the event of inclement weather, as determined by the local school district, the cancellation fee may be waived. To have your fee waived you must contact the therapist prior to your appointment to notify the therapist that you will not arrive due to inclement weather. You are financially responsible for the time you have reserved with your therapist. This is necessary because a time commitment is made to you and is held exclusively for you. If you are late, you may lose some of that session time.

Confidentiality

Legal and ethical standards require us to maintain confidentiality. Information cannot be divulged to any outside parties without your written consent with the following exceptions: if you threaten or attempt to commit suicide or become a danger to yourself or others, we become aware of any real or alleged abuse to children, elderly, or incapacitated people (in which case we are mandated reporters of the State of Illinois), and if we receive a properly issued subpoena accompanied by a court order to produce records.

If your therapist receives clinical supervision, s/he will inform you of that process. If you are here with family members, your therapist will discuss expectations and limitations of confidentiality. We will make reasonable effort to discuss any need to disclose confidential information about you, and we are happy to answer any questions you have about the exceptions to confidentiality.

If we see each other accidentally outside of the therapy office, I will not acknowledge you first. Your right to privacy and confidentiality is of the utmost importance to me, and I do not wish to jeopardize your privacy. However, if you acknowledge me first, I will be more than happy to speak briefly with you, but feel it appropriate not to engage in any lengthy discussions in public or outside of the therapy office.

Social Media Policy

In order to maintain your confidentiality and our respective privacy, we do not interact with current or former clients on social networking websites. Therapists do not accept friend or contact requests, on personal accounts, from current or former clients on any social networking sites including Twitter, Facebook, Instagram, LinkedIn, etc. We will not respond to friend requests or messages through these sites. We will not solicit testimonials, ratings or grades from clients on websites or through any means. We will not respond to testimonials, ratings or grades on websites, whether positive or negative, in order to maintain your confidentiality. Our hope is that you will bring concerns about our work together to the therapy session so we can address concerns directly.

Please do not contact us through text messages or emails regarding clinical issues. These are not a method of secure communication, and there is possibility that we will not get the message in a timely manner, or that communication will be interpreted in an unclear manner. If you need to contact your therapist between sessions, please call 312-852-5290. Text messages and emails are only to be used for scheduling, changing or canceling appointments.

Termination & Transfer Plans

Ending relationships can be difficult. Therefore, it is important to have a termination process in order to achieve some closure. The appropriate length of the termination depends on the length and intensity of the treatment. I may terminate treatment after appropriate discussion with you and a termination process if I determine that the psychotherapy is not being effectively used or if you are in default on payment.

I will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. If therapy is terminated for any reason or you request another therapist, I will provide you with a list of qualified psychotherapists to treat you. You may also choose someone on your own or from another referral source.

Should you fail to schedule an appointment for three consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, I must consider the professional relationship discontinued. In the event of incapacitation, death, or termination of a therapist’s practice at Soul City Therapy during your care, your records will remain in our possession and a new therapist will be made available to you. If you desire to transfer care outside of our practice, you may sign a release of records and we will release a standard extract from your file to the initial intake and most resent progress notes. It is our standard policy to release records directly to another provider. Any variance will be arranged by the designee.

Minors

If you are between the ages of 12 and 18, the law may provide your parents the right to examine your treatment records if after being informed of your parents’ request to examine your records, you do not object or your therapist does not find that there are compelling reasons for denying the access to the records. Notwithstanding the above, your parents are always entitled to the following information: current physical and mental condition, diagnosis, treatment needs, services provided, and services needed. Before giving them any information, your therapist will discuss the matter with you, if possible, and do their best to handle any objections you may have with what is prepared to discuss.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

Notice of Privacy Policies and Clients Rights

For more information see: https://www.hhs.gov/hipaa/index.html

Agreement

I have read and understand the above statement on services, policies, and procedures. 

CONTACT 

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1136 S. Delano Court West, Suite B201, Chicago, IL 60605 tiffany@soulcitytherapy.com    Tel: 312-852-5290