Welcome and thank you for considering my
office (Joyce Kay Hamilton, MLA/LPC) for your mental health needs. This document contains important information
about my professional services and business practices.
Therapist
Joyce Kay Hamilton is a licensed
professional and engages in private practice providing mental health care and mental health services to clients
directly and operates as an independent contractor/provider for various managed care entities.
Mental Health Services
While it may not be easy to seek help from a mental health professional, it is hoped that you will be better able
to understand your situation and thoughts/feelings and move toward resolving your difficulties. Using knowledge of
human development and behavior, the therapist will make observations about situations, as well as suggestions for
new ways to approach them. It will be important for you to explore your own feeling and thoughts and to try new
approaches in order for change to occur. You may bring other family members or significant others to a therapy
session, if you feel it would be helpful or if this is recommended by the therapist. However, at that time, the
family member or significant other/s also become/s a client/s and , as such, are privileged to same considerations
said services provide.
Appointments
The preferred way to schedule an appointment is by emailing me through my website email address which is:
You may also call the office number of 214-823-2861 at anytime, as there is a way to leave a message 24 hours a
day. Once we (therapist/client) decide on a workable time/day, the therapist works on standing appointments only and
we (the client and therapist) will meet at the same day/time each week. Of course, situations or events occur that
will prohibit attendance and 2 missed visits are allowed before assessing a cancellation fee. Most times the
insurance company may be billed for the missed appointment or you may opt to pay the cancellation fee yourself on my
website.
Cancellations
You are responsible for contacting the therapist regarding appointment time changes, not your spouse or other
significant person in your life. Of course, there may be extenuating circumstances (such as: hospitalization) which
would require another person to notify the office.
Length of Visits
The session length may vary from 40-45 minutes or even 55-60 minutes, depending upon presenting problem at that
session time. After the initial intake, further evaluation time may be scheduled as needed for the therapist to
accurately assess your mental health needs (this may include testing). Once the evaluation process is completed,
work in the therapy session begin.
Number of Visits
The number of visits of sessions needed depends on many factors and will be discussed by the therapist. Your
initial session will involve an evaluation of your needs and, depending on your circumstances, further evaluation
session time/s may be required. At the end of the first session, the therapist will be able to provide you with some
first impressions of what therapy may include and a tentative treatment plan, if both you and the therapist agree to
move forward. You should evaluate this information along with your own opinions of whether you feel comfortable
working with this therapist. Therapy involves a large commitment of time, money, and energy, so you should be
very careful about the therapist you select. If you have questions about procedures, feel free to discuss
them with the therapist at any time. If you have doubts, your therapist will be happy to help you set up a meeting
with another mental health profession for a second opinion.
Relationship
Your relationship with the therapist is a professional and therapeutic relationship. In order to preserve this
relationship, it is imperative that the therapist not have any other type of relationship with you. Personal and/or
business relationships undermine the effectiveness of the therapeutic relationship. The therapist cares about
helping you but is not in a position to be your friend or to have a social or personal relationship with you.
If the therapist encounters you in a public setting, in order not to reveal your identity, the therapist will not
acknowledge your presence unless addressed by you first. Gifts, bartering, and trading services are rarely
appropriate and typically should not be shared between you and the therapist.
Goals, Purposes, and Techniques of Therapy
There may be alternative ways to effectively treat the problems you are experiencing. It is important for you to
discuss any questions you may have regarding the treatment recommended by the therapist and to have input into
setting the goal/s of your therapy. As therapy progresses, the initial goals, purposes, and techniques of therapy
agreed upon by and the therapist may change during the course of treatment. The therapist may make suggestions for
improvement which involves time outside of therapy (such as: Journaling). Your life happens every day and it is
important to practice mental health techniques outside of the therapeutic arena.
Payment for Services
For individual therapy, the charge/fee for an initial evaluation and subsequent sessions are based upon your
individual insurance plan rate. Various insurance plans have numerous policies in regard to deductibles,
out-of-pocket expenditures, co-pays, co-insurance, and more. The therapist will verify benefits prior to the initial
visit and email you what payment is expected at that visit. The therapist accepts cash/checks in the office. If you
prefer to pay with a charge card, you may pay online at the website (
www.joycekayhamilton.com) by selecting the tab “payments” and pay
through PayPal prior to session time. If you have a health savings account card, the therapist will send you an
invoice (through Square) and you can pay directly from that invoice prior to session time. You are responsible for
and shall pay your co-pay, or other fee, or patient portion for services at the time the services are provided.
There are no exceptions.
Please note:
If you are unable to pay, or are unwilling to pay, the services will be terminated and you will be given
referrals to other competent providers. Although the therapist does accept assignment of insurance benefits, the
therapist will look to you for full payment of your account, and you will be responsible for payment of all
charges. If payment is delayed, a collection agency will be utilized.
Although it is the goal of the therapist to protect the confidentiality of your records, there may be times when
disclosure of your records or testimony will be compelled by law. Confidentiality and exceptions to confidentiality
are disclosed below. In the event disclosure of your records or the therapists testimony are requested by you or
required by law, regardless of who is responsible for compelling the production or testimony, you will be
responsible for and shall pay all of the costs involved in producing the records and the hourly rated charged by the
therapist at the time of the request or service of the subpoena (current rate is $175 per hour) for the time
involved in traveling to and from the testimony location, reviewing records, and preparing to testify, waiting at
the location, and giving testimony. Such payments are to be made the business day prior to the time the services are
rendered by the therapist. The therapist requires a 50% deposit (two (2) business days fore) for anticipated court
appearances and preparation. Time spent reviewing records and preparing to testify are billable and payment is
expected and the bill will not be reduced.
Confidentiality
Discussions between a therapist and a client are confidential. No information will be released without the client’s
written consent unless mandated or permitted by law. Possible exceptions to confidentiality include but are not
limited to the following situations: child abuse; abuse of the elderly or disabled; abuse of patients in treatment
facilities; sexual exploitation; AIDS/HIV and other communicable disease infection and possible transmission; court
orders; criminal and other prosecutions; child custody cases; suits in which the mental health of a party is in
issue; situations where a therapist has a duty to disclose, or where, in the therapist’s judgment it is necessary to
warn, protect, notify, or disclose; sexual exploitation by a mental health professional or member of the clergy; fee
disputes between the therapist and the client; a negligence suit brought by the client against the therapist; the
filing of a complaint with a licensing board or other state or federal regulatory authority; to regulatory
authorities in connection with their compliance or investigatory responsibilities; to employees of agents of the
practice for operational purposes; to a supervisor if the therapist is under supervision, and for treatment
consultations with other mental health professional when deemed necessary by the therapist.
By signing this information and consent form below you acknowledge receipt of a copy of the Notice of Privacy
Practices. If you have any question regarding confidentiality, you should bring them to the attention of the
therapist via email. By signing this information and consent form below, you are giving your consent to the
undersigned therapist to share confidential information with all persons mandated or permitted by law, with the
agency that referred you, and with the managed care company, and/;or insurance carrier responsible for providing
your mental health care services, and payment for those services, and you are also releasing and holding harmless
the undersigned therapist for any departure from your right of confidentiality that may result.
Duty to Warn
In the event that the undersigned therapist reasonably believes that you are a danger (physically or emotionally)
to yourself or to another person, by signing this information and consent form below, you specifically consent for
the therapist to warn the person in danger and contact any person in position to prevent harm to yourself or another
person, in addition to medical and law enforcement personnel, and the following person/s:
This information is to be provided at your request for use by said person ONLY to prevent harm to yourself or
another person. This authorization shall expire upon the termination of your therapy with the undersigned therapist.
You acknowledge that you have the right to revoke this authorization in writing at any time to the extent the
undersigned therapist has not taken action in reliance on this authorization. You further acknowledge that even if
you revoke this authorization, the use and disclosure of your protected health information could possibly still be
permitted by law as indicated in the copy of the Notice of Privacy Practices of the undersigned therapist that you
have received and reviewed.
You acknowledge that you have been advised by the undersigned therapist of the potential of the re-disclosure of
your protected health information by the authorized recipients and that it may not be protected from unauthorized
disclosures as required by the federal Privacy Rule.
You further acknowledge that the treatment provided to you by the undersigned therapist was conditioned on you
providing this authorization.
Risks of Therapy
Therapy is the Greek word for change. You may learn things about yourself that you do not like. Often growth cannot
occur until you experience and confront issues that induce you to feel sadness, sorrow, anxiety, or pain. The
success of our work together depends on the quality of the efforts on both our parts, and the realization that you
are responsible for lifestyle choices/changes that may result from therapy. Specifically, one risk of marital
therapy is the possibility of exercising the divorce option.
After Hours Emergencies
Please know that the undersigned therapist DOES NOT provide twenty-four (24) hour crisis or emergency therapy
services. Should you experience an emergency necessitating immediate mental health attention, immediately call 911
or if you are able to safely transport yourself, go to the nearest hospital emergency room for assistance.
Contacting your Therapist
Your therapist is often not immediately available by telephone. The office number of 214-823-2861 is answered by
voice mail that the therapist will monitor from time to time throughout the day. Although the therapist is typically
in the office during normal business hours, she WILL NOT take calls when with a client. A reasonable effort will be
made to return any call made during normal business hours on the same day it is received, weekends and holidays
excepted. Messages left after hours or on weekends or holiday will normally be returned the next business day. If
you are difficult to reach, please inform your therapist of times when you will be available. To this end, sending
an email may be a better option.
Email and Text Messages
The therapist does not utilize text messaging to contact or dialogue with a client. The therapist does responds in
a timely manner to email communications. Please note: any electronic transmissions of information by you are
retained in the logs of you service providers. While it is unlikely that someone will be looking at these logs, they
are, in theory, available to be read by the system administrators of the service providers. You should be aware that
any email/s received from you and any responses sent will become part of your therapy records.
Social Media
This therapist does not accept friend or contact requests from current or former clients on any social networking
sites. Adding clients as friends or contacts on these sites can compromise confidentiality and privacy of both the
therapist and the client. It can blur the boundaries of the professional relationship and are not permitted. Any
attempt by a client to surreptitiously gain access to the therapist’s personal site/s will be cause for termination
of the therapy.
Therapist’s Incapacity or Death
You acknowledge that in the event the undersigned therapist becomes incapacitated or dies, it will become necessary
for another therapist to take possession of your file and records. By signing this information and consent from
below, you give consent to allowing another person (selected by the undersigned therapist) to take possession of
your file and/or records and provide you with copies upon request, or to deliver them to a therapist of your choice.
Marital or Joint Therapy
If I participate in marital or joint therapy pursuant to which joint sessions are held with the undersigned
therapist, I consent for the undersigned therapist to maintain a single case file for each person – with copies in
each file for all joint sessions – and to release all information contained in the file of either participant upon
request by a participant for his/her file.
Audio and Video Recordings
You acknowledge and, by signing this information and consent form below, agree that neither you nor the undersigned
therapist will record any part of your sessions. You further acknowledge that the undersigned therapist objects to
you recording any portion of your session without the therapist’s written consent.
Defamation
By signing this intake and consent form below you agree that you will not make defamatory comments about the
undersigned therapist to others or to post defamatory commentary about the therapist on any website or social media
site. In the event that defamatory remarks about the therapist are made by you, or others acting in concert with
you, you further consent by signing this intake and consent form below to allowing the therapist to use confidential
information necessary to rebut or defend against, or prosecute claims for, the defamation.
Cooperation of Client
You shall keep the undersigned therapist advised of your whereabouts, and provide the undersigned therapist with
any changes of address, phone number, contact information, or business affiliation during the time period which the
undersigned therapist’s services are required. You shall comply with all reasonable requests of the undersigned
therapist in connection with therapeutic treatment. The undersigned therapist may set boundaries including forms of
client interactions and communication including ceasing to provide services to you for good cause, including without
limitation: your refusal to comply with treatment recommendations, the undersigned therapist or staff is
uncomfortable working with you, or your failure to timely pay fees and/or deposits in accordance with this
Information and Consent Form, subject to the professional responsibility requirements to which the undersigned
therapist is subject. It is further understood and agreed that upon such termination of services of the undersigned
therapist, any of your deposits remaining in the undersigned therapist’s account shall be applied to any balance
remaining which is owing to the undersigned therapist for fees and/or expenses and any surplus then remaining shall
be refunded to you.
Consent to Treatment
I, voluntarily, agree to receive (or agree for my child to receive) Mental Health assessment, care,
treatment, or services, and authorize the undersigned therapist to provide such care, treatment, or services
as are considered necessary and advisable.
I understand and agree that I will participate in the planning
of my care (or my child’s care), treatment, or services, and that I may stop such care, treatment, or
services that I receive (or my child receives) through the undersigned therapist at any time.
By signing this Client Information and Consent form, I the undersigned client (or parent), acknowledge that
I have read, understood, and agreed to be bound by the terms, conditions, and information it contains.
Further, I understand and acknowledge that I will receive a signed copy of this Information and Consent
form. Ample opportunity has been offered to me to ask questions and seek clarification of anything unclear
to me.
