Confidentiality
By law and professional ethics, your sessions are strictly confidential. Generally, no information will be shared with anyone without your written permission. If you are seeing another therapist or health professional, it may be necessary for me to contact that person so that we can coordinate our efforts. If this is necessary, I will ask for your permission. In addition, some insurance companies require periodic updates. I will only provide this information with your permission. There are, however, a number of exceptions to this confidentiality policy.

• If I am ordered by the court to testify or release records.

• If you are a victim or perpetrator of child abuse, I am required by law to report this to the authorities responsible for investigating child abuse.

• If you are a victim or perpetrator of elder or dependent adult abuse, I am required by law to report this to Adult Protective Services or other appropriate authorities.

• If you threaten harm to yourself, someone else, or the property of others, I may be required to call the police and warn the potential victim, or take other reasonable steps to prevent the threatened harm.
   

Treatment of a minor without parental consent is allowed by law
(Civil Code 25.9) if:

• The minor is 12 years of age or older, and the minor is mature enough to participate intelligently in outpatient mental heath treatment or counseling, and the minor has been the alleged victim of incest or child abuse, or without such mental health treatment or counseling the minor would present a danger of serious physical or mental harm to himself/herself or others.
   

After Hours Emergencies
I am not available after my usual business hours for emergencies. I do check my messages for calls concerning rescheduling appointments, confirming appointments, etc. Leave a message on my voicemail, and I will call you back as soon as I retrieve the message. For after-hours emergencies or if you need immediate assistance, call 911, your medical group, or your primary care physician.
 

Vacations
I will give you reasonable notice before I go on vacation. If I am going to be out of town or unavailable, a colleague will be on call for emergencies. The name and phone number of this individual will be on my answering machine. If you feel that you will need continuing treatment during this time, I will help you make arrangements ahead of time with another therapist.
 

Terminating Treatment
You have the right to terminate or take a break from your treatment at any time without my permission or agreement. However, if you do decide to exercise this option, I encourage you to talk with me about the reason for your decision in a counseling session so that we can bring sufficient closure to our work together. In our final session, we can discuss your progress thus far and explore ways in which you can continue to utilize the skills and knowledge that you have gained through your therapy. We can also discuss any referrals that you may require at that time.

Therapists are ethically required to continue therapeutic relationships only so long as it is reasonably clear that patients are benefiting from the relationship. Therefore, if I believe that you need additional treatment, or if I believe that I can no longer help you with your problems, I will discuss this with you and make an appropriate referral.

Please sign this form and keep a copy for yourself for future reference. Should you have any questions at any time, please ask.