KARNER PSYCHOLOGICAL ASSOCIATES
Listed
below is information about procedures and policies of our office. We hope that
this information will help you to use our services most effectively.
Karner Psychological Associates (KPA) provides a full
range of mental health services including assessment, consultation, individual
and group counseling and psychotherapy.
Services are goal oriented and designed to meet specific objectives in
an efficient manner. To help evaluate
these treatment goals, determine appropriate diagnosis and create treatment
plans, a variety of assessments may be part of your experience.
In order for KPA to meet currently
mandated regulatory responsibilities we must request that you take the time to
read and sign all of the enclosed material and forms.
1.
Appointments are scheduled in advance and average 45-50 minutes. Your
prompt arrival is requested.
Appointments cancelled with less than 24 hours notice will be billed to
you (not your insurance company) at the full hourly rate.
2.
Confidentiality is an essential element of our practice but cannot be
guaranteed in cases where self injury is contemplated, or where reporting
of child neglect or abuse is mandated.
We are required to ask you to read the Notice of Privacy Practices
available in our waiting room or on our web site. This may be done at your
first visit to our office or prior to your visit. A copy can be provided to
you.
3.
A telephone answering service is provided for your convenience when our
office staff is not available. To avoid disruption, our therapists typically do
not answer phone calls during treatment sessions. Therefore, if you need to
speak to your therapist, you can leave a message on his/her voice mail. When the office is closed, please leave a
voice mail message for your therapist in our general voice mailbox, or, if your
call is an emergency, please call 243-2169.
4.
In the event of an emergency, the answering service will attempt to
contact your therapist or the therapist on call. It should be recognized, that the services
offered by our office are not crisis oriented. Should there be a high level of
immediacy to your needs, please contact the Crisis Unit at CDPC at 447-9650, or
your local Emergency Room.
5.
We do not routinely call
patients to confirm appointments.
□ I authorize KPA to communicate and
leave messages with me at the phone numbers given to my therapist or our office
staff.
□ I only authorize KPA to communicate and leave messages with
the following people (please include
phone numbers).
_________________________________________________________________
________________________________________________________________________________
□ I do not authorize KPA to communicate and leave messages with me at any time
I have read and understand the above information, and I have a copy of
the KPA Notice of Privacy Practices made available to me.
Name ______________________________________ DOB _________________________
Signature__________________________________ Date _________________________