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Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

Please register here as a new client! You will be asked to complete the initial paperwork, add your billing information, and then you will be able to pick your first initial intake assessment appointment (80 minutes). Our client care coordinator, Tamara, can be reached at 678-999-3390 or Tamara@CounselingATL.com with any questions. We look forward to helping you!

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Terms and Policy

HIPAA: NOTICE OF PRIVACY PRACTICES
The privacy of your health information is important to me. I will maintain the privacy of your health information and I will not disclose your information to others unless you tell me to do so, or unless the law authorizes or requires me to do so.

A new federal law commonly known as HIPAA requires that I take additional steps to keep you informed about how I may use information that is gathered in order to provide health care services to you. As part of this process, I am required to provide you with the attached Notice of Privacy Practices and to request that you sign the attached written acknowledgement that you received a copy of the Notice. The Notice describes how I may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. This Notice also describes your rights regarding health information I maintain about you and a brief description of how you may exercise these rights.

If you have any questions about this Notice please contact Stephanie Cook, LCSW at (678) 999-3390

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I am required by applicable federal and state law to maintain the privacy of your health information. I am also required to give you this Notice about my privacy practices, legal obligations, and your rights concerning your health information ("Protected Health Information" or "PHI"). I must follow the privacy practices that are described in this Notice (which may be amended from time to time).

For more information about my privacy practices, or for additional copies of this Notice, please contact me using the information listed in Section II G of this notice.


I. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION ("PHI")

A. Permissible Uses and Disclosures without Your Written Authorization
I may use and disclose PHI without your written authorization, excluding Psychotherapy Notes as described in Section II, for certain purposes as described below. The examples provided in each category are not meant to be exhaustive, but instead are meant to describe the types of uses and disclosures that are permissible under federal and state law.
1. Treatment: I may use and disclose PHI in order to provide treatment to you. For example, I may use PHI to diagnose and provide counseling service to you. In addition, I may disclose PHI to other health care providers involved in your treatment.

2. Payment: I may use or disclose PHI so that services you receive are appropriately billed to, and payment is collected from, your health plan. By way of example, I may disclose PHI to permit your health plan to take certain actions before it approves or pays for treatment services.

3. Health Care Operations: I may use and disclose PHI in connection with our health care operations, including quality improvement activities, training programs, accreditation, certification, licensing or credentialing activities. Specifically, if you are a client for whom I file insurance I will need to disclose PHI to ProClaims Medical Management, Inc.-my practice administrator. ProClaims Medical Management is bound by this confidentiality agreement.

4. Required or Permitted by Law: I may use or disclose PHI when I am required or permitted to do so by law. For example, I may disclose PHI to appropriate authorities if I reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. In addition I may disclose PHI to the extent necessary to avert a serious threat to your health or safety or the health or safety of others. Other disclosures permitted or required by law include the following: disclosures for public health activities; health oversight activities including disclosures to state or federal agencies authorized to access PHI; disclosures to judicial and law enforcement officials in response to a court order or other lawful process; disclosures for research when approved by an institutional review board; and disclosures to military or national security agencies, coroners, medical examiners, and correctional institutions or otherwise as authorized by law

B. Uses and Disclosures Requiring Your Written Authorization

1. Psychotherapy Notes: Notes recorded by your clinician documenting the contents of a counseling session with you ("Psychotherapy Notes") will be used only by your clinician and will not otherwise be used or disclosed without your written authorization.

2. Marketing Communications: I will not use your health information for marketing communications without your written authorization.

3. Other Uses and Disclosures: Uses and disclosures other than those described in Section I.A. above will only be made with your written authorization. For example, you will need to sign an

authorization form before I can send PHI to your life insurance company, to a school, or to your attorney. You may revoke any such authorization at any time.



II. YOUR INDIVIDUAL RIGHTS

A. Right to Inspect and Copy. You may request access to your medical record and billing records maintained by me in order to inspect and request copies of the records. All requests for access must be made in writing. Under limited circumstances, I may deny access to your records. I may charge a fee for the costs of copying and sending you any records requested. If you are a parent or legal guardian of a minor, please note that certain portions of the minor's medical record will not be accessible to you.

B. Right to Alternative Communications. You may request, and I will accommodate, any reasonable written request for you to receive PHI by alternative means of communication or at alternative locations.

C. Right to Request Restrictions. You have the right to request a restriction on PHI used for disclosure for treatment, payment or health care operations. You must request any such restriction in writing addressed to the Privacy Officer as indicated below. I am not required to agree to any such restriction you may request.

D. Right to Accounting of Disclosures. Upon written request, you may obtain an accounting of certain disclosures of PHI made by me after April 14, 2003. This right applies to disclosures for purposes other than treatment, payment or health care operations, excludes disclosures made to you or disclosures otherwise authorized by you, and is subject to other restrictions and limitations.

E. Right to Request Amendment: You have the right to request that I amend your health information. Your request must be in writing, and it must explain why the information should be amended. I may deny your request under certain circumstances.

F. Right to Obtain Notice. You have the right to obtain a paper copy of this Notice by submitting a request to the Privacy Officer at any time.

G. Questions and Complaints. If you desire further information about your privacy rights, or are concerned that I have violated your privacy rights, you may contact the Privacy Officer Stephanie Cook, LCSW at 1244 Clairmont Road, suite 204, Decatur, GA 30030. You may also file written complaints with the Director, Office for Civil Rights of the U.S. Department of Health and Human Services. I will not retaliate against you if you file a complaint with the Director or myself.

III. EFFECTIVE DATE AND CHANGES TO THIS NOTICE

A. Effective Date. This Notice is effective on April 14, 2003.

B. Changes to this Notice. I may change the terms of this Notice at any time. If I change this Notice, I may make the new notice terms effective for all PHI that I maintain, including any information created or received prior to issuing the new notice. If I change this Notice, I will post the revised notice in the waiting area of my office. You may also obtain any revised notice by contacting the Privacy Officer.

This Form is educational only, does not constitute legal advice, and covers only federal, not state, law.
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PROFESSIONAL DISCLOSURE STATEMENT
There are two forms listing my policies that I will ask you to read, sign (electronically) and agree to, prior to working with me or any of my graduate level counseling interns. When you log in to my secure client portal to register as a new client, these policies are listed at the bottom of the page. One is called the Professional Disclosure Statement for Counseling ATL, LLCs, DBA "Couples Counseling ATL", listed below:

Welcome to our counseling practice! We are honored that you have chosen to ask us to help you create and explore your possibilities for change.

It is important to me that you know how we will work together. We believe our work will be most helpful to you when you have a clear idea of what we are trying to do. This document is intended to provide answers to some questions clients often ask about that process.

Included in this document is general information about:

Risks and benefits of counseling
Risks and benefits of clinical supervision
Goals of our work together and what my methods are like
Length of working together
How much my professional services cost and how I handle money matters
Other important areas of our relationship

After you read this document, we can discuss how these issues apply to your own situation. Please read all of it and ask me about any parts that are not clear to you. Write down any questions you think of, and we will discuss them before we agree to meet for our first session, either in person or online. After reading and fully understand this document, please sign this document electronically.

STEPHANIE COOK'S CREDENTIALS & WORK EXPERIENCE

I am a Licensed Clinical Social Worker with nearly a decade of clinical experience in the field of social work. I currently have my own office for the general practice of clinical counseling. I am trained and experienced in providing counseling one-on-one, with couples, families, and in groups with adults and adolescents. Earlier in my career, I worked in university counseling center, university employee assistance program, school, community, home, and psychiatric hospital settings. I hold these qualifications:
I earned my license as a Clinical Social Worker in Georgia in 2013.
I earned certification as a Distance Credentialed Counselor in 2013.
I earned my license as a Master Social Worker in Georgia in 2010.
I have a Masters Degree in Social Work from the University of Georgia; this is a program that was approved by the Council for Accreditation of Counseling and Related Educational Programs (CACREP).
I completed an advanced practicum training (internship) in counseling at Ridgeview Institute, a psychiatric hospital in Smyrna Georgia.
I completed a practicum training (internship) in school social work at Athens-Clarke County School system in Athens, GA.
I completed Gottman Couples Therapy level 1 training 2012, and Gottman Couples Therapy levels 2, 3, and all Gottman specialty trainings (substance abuse/infidelity/domestic violence/trauma) in 2015.

I completed Gottman Couples Therapy Certification as a "Certified Gottman Therapist" in 2018.
I completed training to meet all requirements as a licensed master social worker in Georgia.
I am a professional member of the NASW.
I am a professional member of the Georgia Society for Clinical Social Work and currently co-lead the ethics committee. I formerly co-led the LMSW committee for new social workers.
I completed 2 years of supervised clinical work at Emory University Student Counseling Center and Emory University Faculty Staff Assistance Program through a Post-MSW Fellowship. I provided individual, group, couples, and family counseling to staff, faculty, and students. I also taught DBT skills groups.
I worked for one year as a case manager at Ridgeview Institute, a psychiatric and substance abuse treatment center, providing individual, group and family counseling, for the adolescent unit inpatient and outpatient programs. I also taught DBT skills groups. I supervised doctoral counseing students and provided them with feedback on their video-taped counseling sessions.

AN EXPLANATION of the LEVELS of LICENSING in Georgia

The practice of licensed or registered persons in the field of psychotherapy is regulated in the State of Georgia by the Georgia Composite Board of Professional Counselors, Social Workers, and Marriage and Family Therapists. The Georgia Composite Board can be reached at 237 Coliseum Drive, Macon, GA, 31217-3858. Their phone number is (478) 207-2440.

Not all "psychotherapists" in Georgia have formal training, degrees, or clinical experience. The minimum standards required by Georgia to call yourself a "mental health professional" are as follows:

A Licensed Clinical Social Worker, a Licensed Marriage and Family Therapist, and a Licensed Professional Counselor must hold a Master's Degree in their respective disciplines and have at least two or three years of post-Master's clinical supervision, depending on the discipline.
A Licensed Master Social Worker must hold a Master's degree in social work and have completed a licensing examination.
A Licensed Psychologist must hold a Doctorate degree in psychology and have one year of post-doctoral clinical supervision.
A Psychologist Candidate, a Marriage and Family Therapist Candidate, and a Master Social Worker must hold the necessary licensing degree and be in the process of completing the required supervision for licensure.
A Certified Addiction Counselor I (CAC I) must be a high school graduate, and complete required training hours and 1,000 hours of supervised experience.
A CAC II must complete additional required training hours and 2,000 hours of supervised experience.
A CAC III must have a Bachelor's Degree in behavioral health and complete additional required training hours and 2,000 hours of supervised experience.
Coaching or Life Coaching is an unregulated profession. At this time, anyone can hang a shingle and call themselves a "coach". The International Coach Federation (ICF) is an organization that provides training and membership for anyone who wishes to be a "coach". As of 2010, the state of Georgia has yet to place any additional educational requirements or certification requirements on life coaches. Georgia also does not require life coaches to be trained or certified in order to practice.

An counseling intern or intern graduate student is a student in graduate school finishing their master's degree in a counseling-related field.

WHAT to EXPECT from OUR RELATIONSHIP

As a licensed (or preliminarily licensed) mental health clinician, our counselors will use our best knowledge and skills to help you. This includes following the standards of the National Association of Social Workers, or NASW, and other professional organizations. In your best interests, the NASW puts limits on the relationship between a therapist and a client, and I will abide by these. Let me explain these limits, so you will not think they are personal responses to you.

First, I am licensed and trained to practice counseling - not law, medicine, finance, or any other profession. I am not able to give you good advice from these other professional viewpoints.

Second, the state laws and the rules of the NASW require me to keep what you tell me confidential. You can trust me not to tell anyone else what you tell me, except in certain limited situations. I explain what those are in the "About Confidentiality" section of this document. Here I want to explain that I try not to reveal who my clients are. This is part of my effort to maintain your privacy. If we meet on the street or in a social setting, I will not approach you or say "hello." My behavior will not be a personal reaction to you, but a way to maintain the confidentiality of our relationship. You are welcome to approach me, however. I will understand completely if you choose not to approach me!

Third, in your best interest, and following the NASW's standards, I can only be your therapist. I cannot have any other role in your life. In a professional relationship, sexual intimacy is never appropriate and should be reported to the Georgia Composite Board. I cannot, now or ever, be a close friend or socialize with you. Except for the situations I have described above, I will always maintain your privacy. I also ask you not to disclose the name or identity of any other client being seen in this office.

I make every effort to keep the names and records of clients private. I will try never to use your name on the telephone, if clients in the office can overhear it.

If your records need to be seen by another professional or anyone else, I will discuss it with you. If you agree to share these records, you will need to sign a form consenting to such disclosure. This form states exactly what information is to be shared, with whom, and why, and it also sets time limits. You may read this form at any time. And, you may rescind your permission to disclose information at any time. If you have questions about this process, please ask me.

It is my office policy to destroy clients' records 10 years after the end of our therapy. Until then, I will keep your records in a safe place, stored electronically through an encrypted cloud-based practice management system, "CounSol".

If I must discontinue our relationship because of death, illness, disability, or other presently unforeseen circumstances, I ask you to agree to permit me or my legal representative to transfer your records to another therapist of my choice who will assure the confidentiality, preservation, and appropriate access to your records. By signing this document, you are giving your consent to this request.

If we engage in family or couple therapy (where there is more than one client), and you want to have records of our work together sent to anyone, all of the adults present must provide written consent before any information will be released to any third party.

WORKING TOGETHER

Because you will be putting a good deal of time, money, and energy into counseling, you should choose a therapist carefully. I strongly believe you should feel comfortable with the therapist you choose, and hopeful about the work ahead of you. Research shows that when you feel this way, you drastically increase the probability of therapy being helpful to you. Let me describe how I see our work together.

My theoretical approach is both interpersonal and systemic - meaning that I believe nothing happens in a vacuum. Those situations that are affecting you emotionally are also affecting your body and your relationships. For that reason, we will be looking at what supports you and what challenges you in multiple areas of your life.

My work tends to be solution-focused and strength-based. I am influenced by interests in dialectical behavioral, cognitive-behavioral, psychodynamic and relational therapies, internal family systems, Gottman couples therapy method, positive psychology, social justice and women's issues. Based on your unique needs and level of comfort, I may integrate methods and techniques drawn from many different schools of thought including but not limited to journaling, written assignments, role play, bibliotherapy, desensitization, and imagery.

In our work together, you may find that I use both developing and research-based technologies. Technologies are those that may be newer and, in my professional opinion, show promise, such as email, video sessions, phone sessions and online journaling; they have gained strong bodies of research to support and verify their effectiveness. The more established research-based technologies that I use are those which have been in existence long enough to support with clients who have goals similar to yours. Ultimately, my clinical practice is focused on your possibilities - possibilities for healing, possibilities for growth, possibilities for change, possibilities for learning, possibilities for insight and possibilities for understanding.

The most central ideas in my work include the following:

- Challenging and difficult times in our lives are opportunities to learn. If we get "stuck" viewing them merely as "problems," it is very likely that we will repeat those difficult times over and over again and feel like a failure for doing so.

- We all do what we do for a reason -- the choices we make mean something.

- We are all doing the best we can at this point in time. There is a reason for every thought, feeling, and behavior we engage in, even if we don't understand yet. Sometimes we still need to try to do better, but we do not yet have the skills that we need to do so. That is why therapy can be helpful, in building skills for growth and increased capability.

- We take our experiences from childhood (and the lessons we learned from those experiences) into our adulthood. Oftentimes, as adults, we need to unlearn some of those faulty lessons and relearn more effective strategies for solving problems.

- The more time we spend focusing on "problem talk," the more time we spend in the midst of the problem; and, conversely, the more time we spend focusing on "solution talk," the more time we spend in the midst of the solution.

- A goal of my work with you is to help you find solutions and possibilities to the challenges that you are facing today.

- Another goal of my work with you is to help you find new perspectives on past problems and wounds to heal and allow you to keep moving forward towards the kind of relationships you wish to have, the type of person you want to be, and the life you would like to live.

COURAGE and COMMITMENT

Counseling is not like visiting a medical doctor for a simple procedure. It requires your courage and commitment to this work, which may take some time. I will ask you many questions such as "what is important to you," "what do certain experiences mean to you," "what strong feelings are involved," and "what choices you do want to make?" Our work together requires your best efforts to change thoughts, feelings, and behaviors. This is one of the ways that you are an active partner in counseling.

We will plan our work together - the areas to work on, our goals, the methods we will use, commitments we will make, and many other things. We will agree on a plan that we will both work hard to follow. We will continuously look together at our progress and goals. If we think we need to, we can change our plan at any time.

I want you to be able to create steps toward success without me. I encourage you to learn more about the things that we will talk about. I may email articles for you to read or recommend books to help you understand more about the tasks that we undertake. And, I may ask you to keep a journal on your own or through the online client portal about our work together. Your journal will be for your eyes only unless you wish to share it with me.

HOW to MAKE the MOST of OUR WORK TOGETHER

I sometimes take notes during our meetings. You may find it useful to take your own notes in session or on your online journal outside of sessions.

An important part of your therapy will be practicing new skills that you will learn in our sessions. I will ask you to practice outside our time together and we will work to set up homework assignments for you, which I may add to the online web portal for you to complete. I might ask you to do exercises, to keep records, and perhaps to do other tasks to deepen your learning. You will probably have to work on relationships in your life and make longterm efforts to get the best results.

These are important parts of personal change. Change will sometimes be easy and quick, but sometimes it will be slow and frustrating, and you will need to keep trying. There are no instant, painless cures and no "magic pills." However, you can learn new ways of looking at your situation that will be very helpful for changing how you feel and how you react.

FREQUENCY of SESSIONS

Some clients see me for longer periods of time, such as 1-2 years, but most of my clients see me once a week for 3 to 6 months. After that time, we may choose to meet less often for several more months. Counseling then usually comes to an end. The process of ending therapy, called "termination," can be a very valuable part of our work. Stopping therapy should not be done casually, although either of us may decide to end it if we believe it is in your best interest.

If you wish to stop therapy at any time, I ask that you agree now to meet then for at least one additional session to review our work together. At that time, we will review our goals, the work we have done, any future work that needs to be done, and our choices. If you feel that a change in therapists is appropriate, I will be happy to provide you with the names of other clinicians that may be able to assist you. Or, if you would like to take a "time out" from counseling to try it on your own, we should discuss this. By doing so we can often increase the benefits of your "time out."

I may send you a brief set of questions through email about 6 months after our last session. These questions will ask you to look back at our work together; sending them to you is part of my duty as a therapist. I ask that you agree, as part of entering therapy with me, to return this follow-up form and to be very honest about what you tell me then.

LIMITS of the COUNSELING RELATIONSHIP - WHAT EVERY CLIENT SHOULD KNOW

Counseling is a professional service I can provide to you. Because of the nature of counseling, our relationship has to be different from most relationships. It may differ in how long it lasts, in the topics we discuss, or in the goals of our relationship. It must also be limited to the relationship of therapist and client only. If we were to interact in any other ways, we would then have a "dual relationship," which would not be right and may not be legal. The different therapy professions have rules against such relationships to protect us both.

I want to explain why having a dual relationship is not a good idea. Dual relationships can set up conflicts between my own (the therapist's) interests and your (the client's) best interests, and then your interests might not be put first. In order to offer all my clients the best care, my judgment needs to be unselfish and professional at all times.

Because I am your therapist, dual relationships like these are improper:

- I cannot be your supervisor, teacher, or evaluator.

- I cannot be a counselor to my own relatives, friends (or the relatives of friends), people I know socially or business contacts.

- I cannot provide counseling to people I used to know socially, or to former business contacts.

- I cannot have any other kind of business relationship with you besides the counseling itself. For example, I cannot employ you, lend to or borrow from you or trade or barter your services (things like tutoring, repairing, child care, etc.) or goods in exchange for counseling.

- I cannot give legal, medical, financial, or any other type of professional advice.

- I cannot have any kind of romantic or sexual relationship with a former or current client, or any other people close to a client.

There are important differences between counseling and friendship. As your therapist, I cannot be your friend. Friends may see you only from their personal viewpoints and experiences. Friends may want to find quick and easy solutions to your problems so that they can feel helpful. These short-term solutions may not be in your long-term best interest. Friends do not usually follow up on their advice to see whether it was useful. They may need to have you do what they advise. A counselor offers you choices and helps you choose what is best for you. A counselor helps you learn how to solve problems better and make better decisions. A counselor's responses to your situation are based on tested theories and methods of change. You should also know that counselors are required to keep their clients' identities secret. Therefore, I may ignore you when we meet in a public place, and I must decline to attend your family's gatherings if you invite me. Lastly, when our counseling is completed, I will not be able to be a friend to you.

In sum, my duty as a counselor is to care for you and my other clients, but only in the professional role of counselor.

THE BENEFITS and RISKS of THERAPY

As with any powerful treatment, there are risks as well as benefits associated with therapy. You should think about both the benefits and risks when making any treatment decisions. For example, in therapy, there is a risk that clients will, for a time, have uncomfortable levels of anxiety, sadness, guilt, anger, frustration, loneliness, helplessness, or other negative feelings. Clients may recall unpleasant memories. These feelings or memories may bother a client at work or in school. In addition, some people in your community may mistakenly view anyone in therapy as weak, or perhaps as seriously disturbed or even dangerous. Also, clients in therapy may have problems with people important to them. Family secrets may be told. Therapy may disrupt a significant relationship and sometimes may even lead to a divorce. Sometimes, too, a client's problems may temporarily worsen after the beginning of treatment. Most of these risks are to be expected when people are making important changes in their lives. Finally, even with our best efforts, there is a risk that therapy may not work out well for you.

While you should consider these risks, you should also know that the benefits of therapy have been supported by scientists in hundreds of well-designed research studies. People who are depressed may find their mood lifting. Others may no longer feel afraid, angry, or anxious. In therapy, you have an opportunity to talk things out fully until your feelings are relieved or the problems are solved. Your relationships and coping skills may improve greatly. You may get more satisfaction out of social and family relationships. Your personal goals and values may become clearer and more likely to be achieved.

My clients may grow in many directions - as individuals, in their personal relationships, in their career or academics, on their spiritual paths, and in the ability to enjoy their lives. While there is hope that improvement will occur as part of the therapeutic process, there is no guarantee. However, I do not accept clients into my practice that I do not think I can help. Therefore, I will enter our relationship with optimism about our progress.

If you could benefit from a treatment that I cannot provide, I will try to help you to get it. You have a right to ask me about other such treatments, their risks, and their benefits. Based on what I learn about your problems, I may recommend that you consult with a physician or other professional. If I do this, I will fully discuss my reasons with you, so that you can decide what is best. If you are treated by another professional, with your permission I will coordinate my services with them and with your own medical doctor.

If for some reason treatment is not going well, I may suggest that you see another therapist or another professional. As a responsible person and ethical therapist, I cannot continue to treat you if my treatment is not working for you. If you wish for another professional's opinion at any time, or wish to talk with another therapist, I can help you find a qualified person and will provide him or her with the information needed.

USE of TECHNOLOGY

Many clients choose to use the online web portal's scheduling service (through my website), home phones, cell phones, faxes, email, computers, online video sessions, and phone sessions to augment their counseling with me. It is important for you to know that these methods come with additional risks. These risks include but are not limited to the following:

- The possibility of technology failure resulting in messages / information not being received.

- The possibility of misunderstandings is increased with text-based modalities such as email due to the absence of nonverbal / visual cues.

- Use of email may result in various servers creating permanent records of these transactions.

- Many employers and government agencies review email archives on a routine basis, record letters typed on a keyboard, and / or engage in data mining programs to identify transmissions containing specified content.

- My email and the online web portal is not checked daily and may result in a possible lag in turnaround / response.

- Confidentiality may be breached at many points when using electronic communication including unauthorized monitoring / interception of transmissions from your computer and my own; it may also be breached as the information passes through the servers along the route to each other. This means that it is possible that third parties may access your records / communication when you are using an unsecure service (such as gmail, hotmail, etc.)

- What is said online (except through the encrypted, secure online client portal) may be viewed by others.

- Assessment / diagnosis often becomes more difficult without the benefit of face-to-face contact.

- Your insurance may not cover technology-assisted distance counseling.

- Your insurance company may also consider our electronic communication (in all forms) to be part of the medical record and request them.

- Our email communication is encrypted. However, even encrypted email messages can be decoded by motivated hackers.

I cannot guarantee confidentiality when you and I are communicating via cell phone, fax, non-encrypted email, non-encrypted video or computer. These devices could compromise confidentiality. By understanding the inherent risks of the aforementioned devices, you can make an informed choice about when / where / how to use those tools.

Because you now have this knowledge of the risks related to the use of technology, I will assume that if you use any of these methods to contact me, you are giving me permission to do the same. Please note that I do not check email on a daily basis. Otherwise, for the reasons stated above I will only use email, cell phone, fax, email, or computer for therapeutic purposes and by doing so, understand and accept the associated risks. I agree to not tape or video record any in-person or online sessions, or phone sessions, unless we agree to it being useful for treatment.

CONFIDENTIALITY in THERAPY

I will treat what you tell me with great care. My professional ethics (that is, my profession's rules about moral matters) and the laws of this state prevent me from telling anyone else what you tell me unless you give me written permission. These rules and laws are the ways our society recognizes and supports the privacy of what a therapist and client talk about - in other words, the "confidentiality" of therapy.

However, it is important for you to know that I cannot promise that everything you tell me will never be revealed to someone else. There are some times when the law requires me to tell things to others. There are also some other limits on our confidentiality. We need to review these because I want you to understand clearly what I can and cannot keep confidential. You need to know about these rules now, so that you don't tell me something as a "secret" that I cannot keep. These are very important issues, so please read these pages carefully and keep a copy for your records. At our next meeting, we can discuss any questions you might have about confidentiality.

When you or other persons are believed to be in physical danger, the law requires me to tell others about it. Specifically:

- If I come to suspect that you are threatening serious harm to another person, I am required to try to protect that person. I may have to tell the person and the police, or perhaps try to have you put in a hospital.

- If you seriously threaten or act in a way that is very likely to harm yourself, I may have to seek a hospital for you, or to call on your family members or others who can help protect you. If such a situation does come up, I will fully discuss the situation with you before I do anything, unless there is a very strong reason not to.

- In an emergency where your life or health is in danger, and I cannot get your consent, I may give another professional some information to protect your life. I will try to get your permission first, and I will discuss this with you as soon as possible afterwards.

- If I believe or suspect that you (or anyone) are abusing a child, an elderly person, or a disabled person, I must file a report with a state agency. To "abuse" means to neglect, hurt, or sexually molest another person. I do not have any legal power to investigate the situation to find out all the facts. The state agency will investigate. If this might be your situation, we should discuss the legal aspects in detail before you tell me anything about these topics. You may also want to talk to your lawyer.

In any of these situations, I would reveal only the information that is needed to protect you or the other person. I would not tell everything that you have told me.

In general, if you become involved in a court case or proceeding, you can prevent me from testifying in court about what you have told me. This is called "privilege," and it is your choice to prevent me from testifying or to allow me to do so. I usually have no legal or ethical duty to report a crime that occurred in the past or one that is imminent. However, there are some situations where the law, a judge or court may require me to report / testify. These include but may not be limited to the following:
In any situations that involve the welfare of a child such as child abuse / neglect;
In child custody or adoption proceedings, where your fitness as a parent is questioned or in doubt;
In situations involving the physical violence exception of the "duty to warn and protect" statute;
In cases where your emotional or mental condition is important information for a court's decision - including my duty to initiate a 72-hour hold for your evaluation because of imminent danger to yourself or others;
During a malpractice case or an investigation of me or another therapist by a professional group;
I am required to keep records of our work together, such as the notes I take when we meet. Legally, these records are mine, and I have sole ownership of them. You have a right to request that I review these records with me. If I believe that something in your clinical record might harm you, I may omit that information, but I will explain my reason to you.
As a Licensed Clinical Social Worker, I am completely able to practice independently and am not required to be under supervision; however, to continue to improve my clinical skills, and to ensure that my clients are receiving the best care possible, I meet regularly with a group of Licensed Clinical Social Workers, Psychologists, and Psychiatrists for what is called a "supervision group". I may discuss elements of your treatment for what is called "case consultation", and will not reveal any personal information.
In a civil commitment hearing to decide if you will be admitted to or continued in a psychiatric hospital;
When you are seeing me for court-ordered evaluations or treatment. In this case, we need to discuss confidentiality fully because you don't have to tell me what you don't want the court to find out through my report.
There are a few other things you must know about confidentiality and your work with me:
I may sometimes consult with other professionals about your treatment. Those professionals will also be required by professional ethics and the law to keep your information confidential. Likewise, when I am out of town or unavailable, I may ask another therapist to be available to help you. I may give that professional some information about my clients.

CONFIDENTIALITY CONCERNING MONEY MATTERS and INSURANCE
I will not send any statements or other information to your insurance company. I will only give such information to you. The statement, or invoice, is directly available to you at any time through the online web portal. That way, you can see what your insurance company will know about our therapy. It is against the law for insurers to release information about our office visits to anyone without your written permission. Although I believe the insurance company will act legally, I cannot control who sees this information at the insurer's office.

If you have been sent to me by your employer's Employee Assistance Program, the program's staffers may require some information. Again, I hope that they will act legally, but I cannot control who sees this information at their offices. If this is your situation, let us fully discuss any agreement I may have with your employer or the program before we talk further.
If your account with me is unpaid and we have not arranged a payment plan, I can use a collection agency or other legal means to get paid for my professional services.

If you use your health insurance to pay a part of my fees, insurance companies require some information about our therapy. Insurers or managed care organizations ask for much more information about you and your symptoms, as well as a detailed treatment plan.

CONFIDENTIALITY WITH USE OF TECHNOLOGY

I use password protected computers with a full array of security software including anti-spam, anti-hacker, anti-malware, anti-ad as well as a robust firewall. The online video counseling is conducted in a private location, either at my office or my in-home office. I am only willing to do on-line video sessions with clients with whom I have already deemed appropriate for said services based on my clinical judgment. I also reserve my right to decide that video services are no longer appropriate and end these services at any time.

To participate in online video counseling, you agree to be alone in a private room, to not tape or record sessions, and to use a computer that has Adobe flash player, a web cam and high speed internet connection. You are required to use security systems such as anti-virus, anti-malware, etc., to insure that your privacy is protected. Despite safeguards, absolute confidentiality and privacy cannot be guaranteed over the internet.

I use a vendor, CounSol, a Cloud-Based Practice Management system, to store client records electronically with an encryption system. I do share limited protected health information (PHI) with this vendor for the purposes of fulfilling my administrative duties. This vendor allows me to keep my clients' information safe and secure with their HIPAA compliant encryption system. As the counselor, I am the only one who has access to the encrypted client information. Servers are housed in Tier-IV data center with SSAE16, HITRUST, ISO 27001 & PCI 2.0 compliance. PCI (Payment Card Industry) standards are applied to the internal systems and software. All traffic is required to use SSL (Secure Socket Layer) with 256-bit encryption. Unique login is required for all users and logging of all user activity. There is a 256-bit encryption of all sensitive data. No sensitive information is sent via email--only notifications to login will be sent. Data is backed up hourly using 256-bit encryption.

SPECIAL TECHNOLOGY CONCERNS

Distance counseling (either via online video, phone) have some unique challenges. I require that I all clients complete initial paperwork online prior to our intitial counseling session. This help ensure appropriate delivery of counseling and level of care needed for each client. I reserve the sole right to determine whether or not a client is appropriate for service, prior to beginning any in person or distance counseling. By law, a minor must have parental consent to participate in counseling. As such, part of informed consent is the acknowledgement that a person requesting counseling sessions is an adult. Should a minor wish for either in-person or distance counseling sessions, parental or legal guardian consent must be obtained through the parental consent form. Also, I require at least one in-person contact with both the minor client and their legal guardian during an initial session prior to any form of distance counseling session. I reserve the sole right to make any exceptions based on clinical appropriateness.

Because there is always the possibility of technology failure and computer crashes, alternate modes of communication are recommended, but not required. Should power or technology failures occur, it is assumed counselor and client will reconnect once those failures have been rectified. If such a technical failure occurs, I will contact you via phone to determine next steps.

Last, but by far not the least of special concerns, is the issue of misunderstanding. Because online text based counseling such as email is devoid of so many vocal and visual cues and clues, misunderstanding is possible. Every attempt is made to be as clear and straight forward as possible. Nevertheless, if a misunderstanding does occur, it will be up to the client and this counselor to work out a satisfactory solution, such as rescheduling or continuing counseling using a different modality, such as in person, online video, or the phone.

CONFIDENTIALITY with CHILDREN and FAMILIES

When I treat clients between the ages of 11 and 18, I require that all legal parents / guardians who still have rights to the child/adolescent be willing to consent to treatment prior to beginning treatment with a child or adolescent. I use my professional clinical judgment to determine what information will remain confidential between the child/adolescent and myself and what information is appropriate to be shared with parents / guardians concerning treatment issues. However, parents / guardians do have the right to general information, including how therapy is going and dates of service. They need to be able to make well-informed decisions about therapy. The law may also require me to tell parents or guardians some information about other family members that I am told. This is especially true if these others' actions put the client or others in any danger.

In cases where I treat several members of a family (parents and children or other relatives), the confidentiality situation can become very complicated. I may have different duties toward different family members. At the start of our treatment, we must all have a clear understanding of our purposes and my role. Then we can be clear about any limits on confidentiality that may exist.

In couples counseling, if you tell me something your spouse or partner does not know, and not knowing this could harm him or her or your relationship, I cannot promise to keep it confidential. I have a "no secrets" policy when working with couples, and will not keep secrets. Please only tell me what you feel comfortable with your partner knowing. I will work with you to decide on the best longterm way to handle situations like this.

If you and your spouse have a custody dispute, or a court custody hearing is coming up, I will need to know about it. My professional ethics prevent me from doing both therapy and custody evaluations, so I choose to not do custody evaluations, and will refer you to a different counselor if you need this service.

If you are seeing me for couples counseling, you must agree at the start of treatment that if you eventually decide to divorce, you will not request my testimony for either side. The court, however, may order me to testify.

At the start of family treatment, we must also specify which members of the family must sign a release form for the common record I create in the therapy or therapies.

And, finally, all participants in couples / family therapy must not disclose any knowledge gained during the course of therapy without the consent of the person to whom the knowledge relates.

CONFIDENTIALITY in GROUP THERAPY

In group therapy, the other members of the group are not therapists. They do not have the same ethics and laws that I have to work under. You cannot be certain that they will always keep what you say in the group confidential. However, if you are a participant in group therapy, you must NOT disclose any knowledge gained during the course of therapy without the consent of the person to whom the knowledge relates.

OTHER INFORMATION about CONFIDENTIALITY

I will not record our therapy session on audiotape or videotape without your written permission.

If you want me to send information about our therapy to someone else, you must sign a "release of information" form. I have copies you can see, so you will know what is involved. I can provide this online or in person.

Any information that you also share outside of therapy, willingly and publicly, will not be considered protected or confidential by a court.

The laws and rules on confidentiality are complicated. Please bear in mind that I am not able to give you legal advice. If you have special or unusual concerns, and so need special advice, I strongly suggest that you talk to a lawyer to protect your interests legally and to act in your best interests.

ABOUT OUR APPOINTMENTS

I am available to work with you at regularly scheduled appointment times. If you wish, I will be happy to reserve a regular standing appointment time for you into the foreseeable future. You may also do so by visiting the online scheduling system through the online client portal. The very first time I meet with you, we will need to give each other much basic information. Most clients usually meet with me for a standard 45 minute session once a week for a while, and gradually taper off to less frequent appointments. Some clients choose to meet with me for extended 80 minute sessions, or even twice weekly. Some clients prefer more intensive therapy up to several hours per week, several times per week. We can schedule meetings for both your convenience and based on what works best towards meeting your goals.

An appointment is a commitment to our work together. We both agree to meet and to be on time. If I am ever unable to start on time, it will most likely be due to an emergency and I ask for your understanding. I assure you that you will receive the full time agreed to. If you are late, we will probably be unable to meet for the full time, because it is likely that I will have another appointment after yours.

CANCELLATION POLICY

I make every effort to accommodate as many clients as possible during the limited time I have available during the week. For that reason, it is necessary to have a cancellation policy that is fair and reasonable for all concerned. I will consider our meetings very important and ask you to do the same. Your session time is reserved only for you.

Please try not to miss sessions if you can possibly help it. A cancelled appointment delays our work. When you must cancel, please give me at least 48 hours notice by telephone or through the secure online web portal. I do not check email every day, so this is not the best way to cancel or reschedule. I am rarely able to fill a cancelled session unless I know at least 48 hours in advance. If you are unable to provide at least 48 hours notice when you cancel, you will be charged the full fee for your session unless I am able to fill it with another client. I will charge the credit card that is kept on file that you have given me permission to charge for all payments and fees. You should note that insurance companies will not typically reimburse you for missed appointments. The only time I will waive this fee is in the first event of serious or contagious illness, extreme weather, family or personal emergency. I reserve the right to decide whether or not I will waive my fee.

FEES, PAYMENTS, and BILLING

Payment for services is an important part of any professional relationship. This is even truer in therapy; one treatment goal is to make relationships and the duties and obligations they involve clear. You are fully responsible for seeing that my services are paid in full. Meeting this responsibility shows your commitment and maturity.

It is my policy to keep a credit card on file to be used for payment, late cancellations, or other types of professional services rendered. I accept Visa, MasterCard, American Express, or Discover. I will bill your card on file as soon as the end of each session. This prevents you from having a past-due balance and keeps our therapeutic relationship free of financial tension. You may choose to use a different form of payment, including cash. I do not accept personal check. You may also pay via PayPal through the "Billing" section located on the online web portal.

You will be given at least 30 days notice in advance if my fees should change. My current regular fees are as follows:

Regular therapy services: For all 45 minute sessions, either in person, or online video, my fees are $180. For all 30 minute sessions, either in person, phone or online video, my fees are $90, except for the first phone call with a new client (free consultation). Other payment or fee arrangements must be worked out before our first meeting. I offer clinical supervision for the same rate unless otherwise specified. My masters level employees offer counseling at $150 per initial session and $125 per session thereafter; my graduate level counselors offer counseling at $100 per initial session and $75 per hourly session thereafter. Their services cannot be used in conjunction with insurance, and we will not provide a "superbill" for their services.

For scheduled sessions, if you have not arrived within fifteen minutes of the scheduled appointment and there has been no ability to connect with an outreach attempt, the session will be treated as a cancellation without 48 hour notification.

Should your account become 60 days past due and arrangements for payment have not been agreed upon, I have the right to use legal means (collection agency or court system) to secure payment. In this event, I respect client's confidentiality and only release a client's name, the dates and nature of services provided and the dollar amount due.

Telephone consultations / appointments: I believe that telephone consultations may be suitable or even needed at times in our therapy. If so, I will charge you our regular fee, prorated over the time needed. If I need to have telephone communication that extends beyond 10 minutes with you or outside professionals as part of your treatment, you will be billed for these at the same rate as for regular therapy services. My telephone fee rate is $80 for any amount of time up to a half hour, and $160 for any amount of time 30 minutes up to a full hour. If you are concerned about this policy, please be sure to discuss it with me in advance so we can set a policy that is comfortable for both of us. Of course, there is no charge for brief calls less than 10 minutes related to scheduling and cancelling of appointments, or for pre-planned "between session coaching calls" that I have instructed you to do as part of treatment.

Extended sessions: Occasionally, it may be better to go on with a session rather than stop or postpone work on a particular issue. When this extension is more than 5 minutes, I will consult with you, because sessions that are extended beyond 5 minutes will be charged more. To extend a regular 45 minute session (fee $180) to 80 minutes, the fee will be adjusted to $270.

Hospital visits /consultation with other professionals : $180 per hour. Appointments at alternative locations such as hospitals and other therapist offices will be based on travel time, portal to portal, and the time involved in providing the required service at my regular fee schedule. Some services may require payment in advance.

I realize that my fees involve a substantial amount of money, although they are well in line with similar professionals' charges. For you to get the best value for your money, we must work hard and well.

I will assume that our agreed-upon fee-paying relationship will continue as long as I provide services to you. I will assume this until you tell me in person, by telephone, or by certified mail that you wish to end it. You have a responsibility to pay for any services you receive before you end the relationship.

Because I expect full payment at the time of our meetings, I usually do not send bills. If you wish, I will provide a "superbill" receipt at the conclusion of each session, which will provide you with the time spent in session, how much you paid, the CPT (billing) code, and diagnostic codes (when applicable). That statement can be used for health insurance claims, as described in the next section. This is only applicable to work with me, Stephanie Cook, LCSW; this is not applicable to my pre-licensed master level therapists or graduate level interns.

If you think you may have trouble paying your fees on time, please discuss this with me. If this occurs, I will also raise the matter with you so we can arrive at a solution. If there is any problem with my charges, my billing, your insurance, or any other money-related point, please bring it to my attention. I will do the same with you. Such problems can interfere greatly with our work. They must be worked out openly and quickly.

If your bill remains unpaid for an excessive amount of time, I am required to suspend therapy with you. Fees that continue unpaid after this may be turned over to small-claims court or a collection service. In the event that it is necessary to commence proceedings to collect money owed for professional services rendered, you will be expected to pay reasonable collection costs and fees incurred, including but not limited to attorney's fees.

MANAGED CARE and YOUR THERAPY CHOICES

I have made the choice not to contract with Insurance companies, also called "Managed Care Companies" (MCC), for my professional services. Listed below you will find my thoughts concerning this decision.

Conflicts of Interest - As a Licensed Clinical Social Worker, I am required to avoid potential conflicts of interest. My primary concern is for your well-being. Therapists working under the constraints of MCC are sometimes put in the position of having to choose between what is in their own best interest and what is in their client's best interest.

Managed Care Companies were created to "manage" and contain escalating healthcare costs. Their bottom line is to reduce costs and raise profits; it is not to increase the quality of care or quality of life for you. In many cases, therapists who contract with MCC are actually paid to NOT see clients.

Restricted Choice - Often MCC restrict your choice of therapist by offering only short term / brief therapy that I refer to as "drive-by" therapy which meets the financial criteria of MCC but may fail to afford you the opportunity to get the information / therapy that you want / need. It is my belief that this often results in your quality of care being compromised. This, of course, can result in the possibility of your needs going unmet.

Managed Care Companies often choose to limit what therapies are offered, restrict what is discussed in therapy, and decide which clients can be seen and for how long. Some MCC have even included "gag clauses" in their contracts to prevent therapists from suggesting more effective (sometimes more expensive) treatments

Professional Expertise - I believe that you should be able to access the full range of mental health professionals according to your needs. Often MCC restrict the professionals that you are allowed to work with - preferring to refer you to therapists who have a record of providing short term therapy rather than to other therapists who may provide better results or offer a different packaging of services.

Contractual Limitations - I believe that you have the right to full disclosure of any arrangements, agreements or restrictions between any third party and me that could interfere with or impact your treatment. Managed Care Companies may label counselors' choices to advocate for clients in this manner as "Managed Care Unfriendly Behaviors" and take such actions as they deem fit. Typically "violations" such as these result in therapists being removed from provider panels or censured in other ways.

Privacy / Confidentiality - By contracting with MCC, it is likely that I would be required to share your deeply personal information with gatekeepers and utilization review professionals; it would mean potentially allowing literally hundreds of other to have access to your personal information.

Medication - Research has consistently shown that medication for problems with mood is most effective when combined with psychotherapy. Nevertheless, MCC frequently approve medication only for their members rather than permitting them to also work with a mental health counselor. Again, the appearance is that of being more concerned about money rather than my client's needs.

Time - Managed Care Companies usually require therapists to justify and convince Utilization Review members before treatment is approved / continued. This is time consuming for the therapist and for the client who is required to continue her therapy in "fits and starts."

Diagnosis and Stigma - Managed Care Companies typically cover only those services deemed "medically necessary" which is defined as being literally about life and death and the treatment of illness. This means that they require a diagnosis of mental illness for my clients.

My practice is solution-focused on your quality of life and your desires. We spend our time talking about prevention, personal growth, and exploration rather than simply survival.

IF YOU CHOOSE to FILE ON YOUR INSURANCE, TRADITIONAL (or "INDEMNITY") HEALTH INSURANCE PLAN or OPT to GO OUT of NETWORK

Because I am a Licensed Clinical Social Worker, many health insurance plans will help you pay for therapy and other services that I offer. Because health insurance is written by many different companies, I cannot tell you what your particular plan covers. Please read your plan's informational booklet regarding coverage for "Outpatient Psychotherapy" or under "Treatment of Mental and Nervous Conditions." Or, call your employer's benefits office to find out what you need to know.

If your health insurance will pay part of my fee, I can help you with your insurance claim forms. However, please keep two things in mind:

1. I have no role in deciding what your insurance covers. Your employer decided which, if any, services will be covered and how much you will be reimbursed. You are responsible for checking your insurance coverage, deductibles, payment rates, co-payments, and so forth. Your insurance contract is between you and your company; it is not between me and the insurance company.

2. You - not your insurance company or any other person or company - are responsible for paying the fees we agree upon. I do not bill insurance companies for your reimbursement or my fees. I require my payment to come directly from you.

To seek payment from your insurance company, you must first obtain a claim form from your employer's benefits office or call your insurance company. Complete the claim form. Then attach my statement to the claim form and mail it to your insurance company. My statement already provides the information asked for on the claim.

IF YOU NEED to CONTACT ME

Stephanie Cook, LCSW

675 Seminole Ave.

Suite 210

Atlanta, GA 30307

678-999-3390


IF YOU NEED to CONTACT MY OTHER EMPLOYEES OR GRADUATE INTERNS

The best way to reach the counselors or graduate counseling interns is via the online web portal messaging portal. This is to be used solely for scheduling purposes, and not for clinical matters. They will not respond to clinical matters, and you will need to address clinical patterns in session only. If you are running late for a session, or are not going to be able to make it to a session, you may reach the counselors via phone by leaving a message. They will not return your calls. They have been instructed to only speak with you in person during sessions, unless otherwise notified:


Jessica Settle, 678-999-3390 extension 502

Bridge Beatty, 678-999-3390 extension 504

David Blanchard, 678-999-3390 extension 503

Stephanie Cook, 678-999-3390 extension 505

Lynn Louise Wonders, 678-999-3390 extension 506


Although I may be in my office Tuesday through Friday, I do not take phone calls when I am with a client. The best way to reach me is always by phone or email. You can always leave a message on my voice-mail and I will return your call as soon as I can. Generally, we will return messages within 48 hours except on non-working days (Saturday, Sunday, Monday) and holidays. 

I do not--nor do my employees--provide crisis counseling and cannot promise that we will be available at all times. If you feel urgency, and would like to schedule a session soon, please do so thorough the online portal. If you are in need of immediate support, you should call one of the following:

- 911 or

- Dekalb County Mental Health office at 1-800-715-4225 or

- Georgia Crisis & Access line (1-800-715-4225) or

- Fulton County Department of Mental Health office at (404) 730-1600 or

- www.befrienders.org

DIVORCE / CUSTODY DISPUTES

If you ever become involved in a divorce or custody dispute, I will NOT, nor will my employees or counseling interns, provide evaluations or expert testimony in court. You should hire a different mental health professional for any evaluations or testimony you require. This position is based on two reasons: (1) My statements will be seen as biased in your favor because we have a therapy relationship; and (2) the testimony might affect our therapy relationship, and I must put this relationship first. By signing this document, you are acknowledging your full understanding of and agreement to my position on this matter.

STATEMENT of PRINCIPLES and COMPLAINTS PROCEDURES

It is my intention to fully abide by all the rules of the National Association of Social Workers (NASW) and by those of my state licenses.

Problems can arise in our relationship, just as in any other relationship. If you are not satisfied with any area of our work, please raise your concerns with me at once. Our work together will be slower and harder if your concerns with me are not worked out. I will make every effort to hear any complaints you have and strive to seek solutions to them.

If you feel that I, or any other therapist, has treated you unfairly or has even broken a professional rule, please tell me. You can also contact the state or local counseling association and speak to the chairperson of the ethics committee. He or she can help clarify your concerns or tell you how to file a complaint.

In Georgia, the practice of both licensed and unlicensed persons in the field of mental health is regulated by a regulating body, the Georgia Professional Licensing Board, which includes two subsidiary boards: 1) Georgia Composite Board of Professional Counselors, Social Workers, and Marriage and Family Therapists, and 2) the Georgia State Board of Examiners of Psychologists. The Georgia Composite Medical Board is a separate regulating board under which Psychiatrists are regulated.

You may contact the Georgia Professional Licensing Board, the organization that licenses those of us in the independent practice of 1) professional counselors, clinical social workers, marriage and family therapists, or 2) psychologists at:

Georgia Professional Licensing Board
Complaint Division
237 Coliseum Drive
Macon, GA 31217-3858
(478) 207-2440

You may contact the Georgia Composite Medical Board that licenses independent practice of psychiatrists at:

Georgia Composite Medical Board
Enforcement Unit
2 Peachtree Street, N.W., 36th Floor
Atlanta, Georgia 30303
(404) 657-6494 or (404) 656-1725

In our practice, we do not discriminate against clients because of any of these factors: age, gender, marital / family status, race, color, religious beliefs, ethnic origin, place of residence, veteran status, physical disability, health status, sexual orientation, or criminal record unrelated to present dangerousness.

This is a personal commitment, as well as being required by federal, state, and local laws and regulations. We will always take steps to advance and support the values of equal opportunity, human dignity, and racial/ethnic/cultural diversity. If you believe you have been discriminated against, please bring this matter to my attention immediately.

YOUR RIGHTS AS A CLIENT IN THERAPY

1. You have the right to be informed about the qualifications of your therapist including education, experience, clinical certification(s), and license(s).

2. You have the right to receive an explanation of services offered including methods of therapy, the techniques used, your time commitments, fee scales, and billing policies prior to receipt of services.

3. You have the right to be informed of the limitations of the therapist's practice to special areas of expertise (e.g. career development, ethnic groups, etc.) or age group (e.g. children, adolescents, older

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Payment, Cancellation, No-Show, and Insurance Policy - Updated March 2018
Payment Due At Time of Service

Payment for services is an important part of any professional relationship. You are fully responsible for making sure that services are paid in full the day of session, and no later. 

Pricing for Stephanie Cook, LCSW

The fee for the first "initial assessment" counseling session with Stephanie Cook, LCSW, is $295; it is 80 minutes. Thereafter, sessions fees with Stephanie Cook, LCSW, are $195 for the standard 45 minute sessions and $295 for 80 minute sessions ("extended session"), unless otherwise specified. Same hourly rates apply for longer marathon sessions.

The 7 Principles Workshop for Couples are $425 per couple. Every year, I re-evaluate my fees and will let you know (within 30 days) if my fees will change. 

Pricing for Pre-Licensed Master Level Therapist

Jessica Settle, MFT, has completed her graduate degree in counseling and is currently pursuing her license. She first completed the internship at Counseling ATL, LLC, and all three levels of Gottman couples therapy training. She offers 80 minute counseling sessions for $225 for the initial session, and $225 for every 80 minute couples session thereafter. For individuals, the 45 minute session rate is $175. Her services cannot be used in conjunction with any insurance as a pre-licensed therapist. You will not be provided with a "superbill receipt".


David Blanchard, MFT, completed his graduate degree in counseling (May 2019) and is currently pursuing his license. He first completed the internship at Counseling ATL, LLC, and all three levels of Gottman couples therapy training. He offers 80 minute counseling sessions for $175 for the initial session, and $175 for every 80 minute couples session thereafter. For individuals, the 45 minute session rate is $130. His services cannot be used in conjunction with any insurance as a pre-licensed therapist. You will not be provided with a "superbill receipt".


Their services cannot be used in conjunction with any insurance. You will not be provided with a "superbill receipt".


Insurance

Stephanie Cook, LCSW, is not an "in network" provider for any insurance panels, and will not complete any paperwork for insurance panels. If you wish to be reimbursed for your services with her, you can download what is called a "superbill" from her website for your session fees, which serves as a receipt. Contact your insurance company to see how much you may or may not be reimbursed for her services. Jessica Settle, Lindsey Coltraine, and David Blanchard are pre-licensed. They cannot and will not provide any "superbill" to be used with insurance companies. By choosing to work with a graduate counseling intern, you are agreeing to not use your insurance in any way for her counseling services.

Requirement: Credit Card On File 

It is our policy to keep an authorized credit card on file to be used for all professional services rendered, as well as late cancellations, fees, etc. This prevents you from having a past-due balance and keeps our therapeutic relationship free of financial tension. For payment, you may choose to use any credit or debit card with a Visa, MasterCard, American Express or Discover logo. Should your payment be denied for insufficient funds, you will be charged a penalty fee of $25 / per incident. You will be given at least 30 days notice in advance if my fees should change. If you miss a session or cancel a session with less than 48 hours advance notice, you shall be charged for the full session fee. Any phone calls lasting longer than 5 minutes will accrue the standard charge of an individual face-to-face session ($190/hour for Stephanie Cook, LCSW, $175/45 minute session for Jessica Settle, MFT, or $130 for David Blanchard, MFT.

All client information, including debit and credit card information, is stored and processed using all the required components for HIPAA compliance. Servers housed in Tier-IV data center with SSAE16, HITRUST, ISO 27001 & PCI 2.0 compliance. PCI (Payment Card Industry) standards applied to our internal systems and software. All traffic is required to use SSL (Secure Socket Layer) with 256-bit encryption. There is a unique login for all users and logging of all user activity. There is a 256-bit encryption of all sensitive data. No sensitive information is sent via email, only notifications to login will be sent. Data is backed up hourly using 256-bit encryption.

By providing your electronic signature below, you are agreeing to these terms.

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Contact Permission Form

Couples Counseling ATL is committed to ongoing improvement of the counseling services we provide, and to offering new, quality services based on our clients' needs. In order to ensure that all of our counselors are providing high quality services, we may check in with their current or past clients to request (optional/voluntary) feedback regarding their care, to request any constructive feedback regarding the counseling services they receive(d). We also provide quality care by informing past and current clients about changes to our practice and new services. By signing this form, you give us permission to contact you in order to ask you for your feedback about how our services could improve, and to inform you of future service offerings. We will also add you to our email list to inform you of future workshops, groups, and other new services we provide.

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