- Please do your best toward success in the program: Therapy is an important investment in yourself, and to enhance quality of life. Please ask for any handout of interest, ask questions at any time and about any protocol or methodology, practice your favorite health strategies regularly, cultivate a yearning for positive change, be open-minded and proactive, and do the assignments that you are comfortable with outside of therapy with an interest toward self-improvement. Dr. Allen is here to help in any way he can.
- All sessions are 50 minutes – unless client & Dr. Allen discuss longer sessions (prorated). Full payment for services rendered will be required at the end of each session: Dr. Allen’s fees are within the usual and customary range for this community. Your session fee is to be paid at the time of service. Session time can be extended at a pro-rated hourly fee. Your hourly fee also covers cost of handouts and materials, CDs, administration of your file, preparation of resources, and brief phone time in between
- Please be on time & 24-hours notice required for any cancellations. Please keep rescheduling to a minimum. If you prefer, Dr. Allen will work to help you find a comfortable weekly time slot. Please contact Dr. Allen at least 24 hours before an appointment to cancel or reschedule. Clients with Blue Cross HMO will be expected to pay a fee of $100.00 for canceled or missed sessions, unless given 24-hours notification to Dr. Allen.
- Contact outside of therapy: Dr. Allen can be reached at his office (847) 205-9605 or leave a message if you have any questions or need support. Your phone call will be returned soon, but within 24 hours. Please let Dr. Allen know phone numbers where you can be reached, and how to leave confidential voice messages for you. If you prefer to email, please note that emailing is not always private due to the lack of protection on the Internet. Allen will do everything possible to protect client information on the Internet, but cannot be held responsible for privacy using this form of communication.
- Emergency situations: If in need, Dr. Allen will take necessary measures to help you be safe during therapy and build a support network or crisis management plan. For serious emotional concerns or suicidal feelings outside of therapy, always go to the emergency room at a local hospital first. Dr. Allen can be reached at his 24-hour pager during non-working hours, only in emergencies (847) 479-0200 – (page 2 times), and Dr. Allen will try to respond to your call as soon as its possible.
- Health insurance: Dr. Allen accepts full payment for services at the end of eachsession unless arrangements are made for monthly payments. Dr. Allen is an out-of-network provider for all insurances, by which many PPO’s and private insurance companies pay a percentage of the fee / session based on mental health benefits available. Dr. Allen will provide an insurance superbill to submit monthly to your insurance company for reimbursement with all the codes and information required. Most HMO’s will most likely not pay for services out of network. Please authorize and confirm insurance benefits by contacting your insurance company, and providing Dr. Allen’s information for the superbill handout. Also, consider insurance co-payment and deductible.
- Confidentiality: The information you tell your therapist will be treated with great care. The psychology APA ethical code and the professional laws of the state require that your therapist not reveal to any other person what you confide during your sessions without your prior written permission. Dr. Allen will provide a HIPAA form that will explain confidentiality and exceptions.
|Signature of Client (or parent/guardian)||Printed Name||Date|
|Minor’s Signature (if client is over 12 years old)||Printed Name||Date|
|Signature of Dr. Ben Allen||Date|
I appreciate your cooperation and support, and to my best ability hope to help you achieve your goals.
Dr. Ben Allen