Josh Levine, LCSW  (your “Provider” or “I”) is proud to provide you with personalized support and care. Please read and sign the following agreement, it lists billing, scheduling and cancellation policies and procedures. If you have any questions, please let me know.

Therapy Services
Therapy is a relationship between people that works in part because of clearly defined rights and responsibilities held by each person. As a client in psychotherapy, you have certain rights and responsibilities that are important for you to understand. There are also legal limitations to those rights and you should be aware of. I, as your therapist, have corresponding responsibilities to you. These rights and responsibilities are described in the following sections.

 Psychotherapy has both benefits and risks. Risks may include experiencing uncomfortable feelings, such as sadness, guilt, anxiety, anger, frustration, loneliness and helplessness, because the process of psychotherapy often requires discussing the unpleasant aspects of your life.  However, psychotherapy has been shown to have benefits for individuals who undertake it.  Therapy often leads to a significant reduction in feelings of distress, increased satisfaction in interpersonal relationships, greater personal awareness and insight, increased skills for managing stress and resolutions to specific problems. There are no guarantees about what will happen.  Psychotherapy requires a very active effort on your part. In order to be most successful, you will have to work on things we discuss outside of sessions. Therapy services will be conducted on a virtual platform, such as doxy.me, Zoom, Skype, Google Meet or FaceTime.

Confidentiality and Compliance 
Josh Levine, LCSW will take appropriate precautions to keep your health information confidential and to not disclose it without your consent. You are also protected under the provisions of the federal Health Insurance Portability and Accountability Act (HIPAA) and any other applicable federal and state laws related to protection of patient information, including but not limited to Public Health Law § 18. There are certain exceptions to when your confidential information would not be protected—for instance, if Josh Levine, LCSW believes that you will harm yourself or another person or are neglecting or abusing a child or a vulnerable adult.

Cost of Services
 Provider’s rate for a 50-60-minute therapy session will be discussed during initial consultation call.

 Payment Methods 
You understand and agree that payment for services shall be made by the end of the business day in which psychotherapy services were rendered, unless otherwise specified. Provider accepts payment in the form of Zelle, PayPal, Venmo or credit card. There will be a 3.5% surcharge for credit card transactions. If Provider is out of network for your insurance, Provider will provide an invoice or superbill for you to submit the claim, but you must be prepared to pay in full for your appointment at the time of service, with one of the aforementioned payment methods.

Cancelation/ Late Policy 
Appointments will ordinarily be 50-55 minutes in duration, once per week at a time we agree on, although some sessions may be more or less frequently as needed. The time scheduled for your appointment is assigned to you and you alone. If you need to cancel or reschedule a session, I ask you provide me at least 24-hours notice. I am happy to reschedule your appointment, if possible.

If you miss, a session without canceling, or cancel with less than 24-hour notice, my policy is to collect the full amount of the session (unless we both agree that you were unable to attend due to circumstances beyond your control).  If you are running late to your appointment, your appointment will still need to end on time. If possible, please notify your provider via email or text message of anticipated delays.

 Professional Records
I am required to keep appropriate records of services that I provide. Your records are maintained in a secure location in the office. I maintain brief records noting that you were seen, your reasons for seeking therapy, the goals and progress we set for treatment, your diagnosis, social, and treatment history, records I receive from other providers, copies of records I send to others and your billing records. Except in unusual circumstances that involved danger to yourself, you have the right to a copy of your file. Because these are professional records, they may be misinterpreted and or upsetting to untrained readers. For this reason, I recommend that you initially review the records with me, or have them forwarded to another mental health professional to discuss the contents. If I refuse your request to access to your records, you have a right to have my decision reviewed by another mental health professional, which I will discuss with you upon your request. You also have the right to request that a copy of your file be made available to any other health care provider at your written request.

Contacting Me
If you call and I am not immediately available, I will return your call as soon as possible, usually within 1-2 business days for non-urgent matters.  You may leave a message on my confidential voice mail. In cases of medical or mental health emergency 1) go to your Local Hospital Emergency Room, 2) call 911, or 3) call 988 to speak with a trained Crisis Line Responder. For more information, please refer to the ‘Electronic Communication Consent’ that was provided to you.

Other Rights
If you are unhappy with what is happening in therapy, I hope you will talk with me so that I can respond to your concerns. Your feedback will be taken seriously and handled with care and respect. You may also request that I refer you to another therapist, and are free to end therapy at any time. You have the right to considerate, safe and respectful care, without discrimination as to race, ethnicity, color, gender, sexual orientation, age, religion, national origin, or source of payment. You have the right to ask questions about any aspects of therapy and about my specific training and experience. You have the right to expect that I will not have social or sexual relationships with clients or with former clients.

Waiver of Liability  
I have received and reviewed the ‘Notice of Practice Policies/Informed Consent to Psychotherapy’ forms as provided by Josh Levine, LCSW, LLC. By signing the ‘Notice of Practice Policies/Informed Consent’ Attestation, I agree to waive, release and discharge Josh Levine, LCSW, LLC from any and all liability, including, without limitation, any injuries that may occur during the provision of services under this Agreement.