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Privacy and Disclaimer

Consent for Services

Upon visiting our office, you will be asked to sign a consent form containing much of the information below. Please understand that in child custody situations where both parents share legal custody, we will be in need of consent from BOTH parents. If the other parent is unwilling to give consent for counseling services, you may speak with your lawyer regarding obtaining a court order for services.


The confidentiality of all materials related to your treatment or your assessment will be protected by the staff of Behavioral Health Services. Clinical information will not be disclosed outside of this office without your written permission to release such information, except where required by law.

It is important to understand that the law requires mental health professionals to release information where there is a suspicion of child abuse or neglect, or when there is an actual threat of a physically violent act that would endanger you or others. Managed care companies can require or encourage that information from your file be shared with your primary care physician in order to coordinate treatment.


We ask that you agree to allow Behavioral Health Services to bill your insurance company on your behalf and acknowledge that you are are ultimately responsible for payment for services rendered. Please understand that you are responsible for contacting your insurance company to inquire whether or not you have outpatient mental health benefits and to inquire if there is a deductible or co-pay. Please know that payments are due at the time of service.

Attendance & Cancellations

In order for progress to take place in therapy, you must attend regularly scheduled appointments. Cancellations require a 24 hour notice (except for emergencies and illness) so that the appointment slot can be made available for other clients. A same day cancellation, except for emergencies, is considered a “No Show.” After three (3) no-shows, your case can be closed.

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