Close
609-285-3204 holly@nemiroffcounseling.com

Informed Consent and Privacy Practices

Introduction:  Counseling is a collaborative relationship between the counselor and client predicated on trust and safety.  Personal growth and positive change can occur in an environment of respect, security and compassion.

Confidentiality

I am professionally and ethically committed to keeping all aspects of our counseling relationship confidential.  However, there are certain disclosures that are mandated by law including child or elder abuse, harm to self or others, or court-ordered disclosures.

If you choose to submit your paid bills to your insurance carrier, they may require information about your care.

Any other disclosures will require a signed release with your terms permitting protected information to be discussed with another party.

Please be aware that email and text messaging are not secure or confidential means of communication.  This should be considered when communicating with me.  I will respond to appointment updates but I will not respond to therapeutic issues via email or texting.

Emergencies

My 24-hour voicemail is 609-285-3204.  I will return your call as soon as possible, but I am not available for emergencies.  Should you have a mental health emergency, call 911 or go to your hospital emergency room.

Fees and Insurance

Payments for your counseling sessions are due and payable at the time of each session.  Sessions are approximately 45 minutes in length.  Fees may be paid with cash, credit or debit card, money order or personal check.  Sessions canceled with less than 24-hour notice incur a $50 fee.

I am not participating with any insurance provider at this time.  If you request one, I will provide a monthly statement of professional services that includes the required information for submission to your insurance carrier for out of network benefits.

Your signature on this form (2 copies) indicates that you understand and accept the terms of entering into a counseling relationship.  If you have any questions before you begin or during the course of your treatment, it is important that you bring them to the attention of the counselor and they will be addressed.

Phone: 609-285-3204
NJ: 37PC00282500
PA: PC003128

Telehealth Sessions are available.  Please contact us for more information.