Services Offered: I, the undersigned client, hereby agree to receive mental health services from Tarica Hillman, a licensed clinical social worker. The services may include, but are not limited to, therapy, and mental health assessments. Therapy is a way to explore mental illness and emotional difficulties. I understand the benefits and risks of therapy. 

Some benefits include learning coping skills and processing experiences.

Some risks include exploring uncomfortable levels of emotions.

Informed Consent:

Fees: I understand that fees are based on the duration of each session. The fee for a 53-60 minute session is $130, and the initial session, which is for an initial assessment, is $140. I agree to pay the agreed-upon fee for each session promptly.

Cancellation Policy: I acknowledge the cancellation policy, requiring a minimum of 24 hour notice for cancellations or rescheduling. Late cancellations or no-shows are subject to a cancellation fee. The first late cancellation or no-show incurs a $25 fee, increasing to $50 for any additional late cancellations or no-shows.

Billing and Payments: I authorize the billing of services rendered to me. Payment is due at the time of service or as otherwise agreed upon. I agree to provide accurate and up-to-date billing information. A credit/debit card is required to secure payment for services, stored securely in our encrypted system.

Confidentiality: I understand that all information shared during sessions will be kept confidential, except in situations where there is a risk of harm to myself or others. The counselor may consult with other professionals for supervision, ensuring the highest quality of care.

Social media: I understand the therapist will not respond to friend requests or other social media requests. 

Professional Records: I have the right to review medical records, but it is discouraged due to potential misinterpretation. A summary of treatment can be provided upon request with proper release.

Contacting Counselor: The office number is 256-806-0206. I understand the preferred methods of communication with the counselor and will adhere to these guidelines. In case of emergency or urgent matters, I will follow the counselor's established procedures for contact. If an emergency occurs, please call the primary care provider or 9-1-1.

Duration and Termination: I understand that the duration of our therapeutic relationship will be discussed and agreed upon collaboratively. Either party reserves the right to terminate services with reasonable notice.