1. **Introduction**
– These Terms and Conditions govern the provision of mental health care services by Passionate Behavioral Health Services.
2. **Services Provided**
– The Provider offers a range of mental health services, including but not limited t0 psychiatric evaluations and medication management.
– The specific services to be provided will be agreed upon between the Provider and the Client prior to commencement.
3. **Confidentiality**
– All information shared during sessions is confidential and will not be disclosed without the Client’s consent, except as required by law (e.g., in cases of suspected abuse, risk of harm to self or others, or court orders).
4. **Appointments**
– Sessions are by appointment only and must be scheduled in advance.
– The Client is expected to arrive on time. If the Client is late, the session will still end at the scheduled time.
5. **Cancellation Policy**
– Clients must provide at least 24 hours’ notice for cancellations or rescheduling.
– Cancellations with less than 24 hours’ notice may incur a fee of $100.
6. **Fees and Payment**
– Fees for services will be discussed and agreed upon prior to the first session.
– Payments are due at the time of service or as otherwise agreed upon in writing.
– Accepted forms of payment include Zelle, Credit Cards, Cash apps and PayPal.
7. **Insurance**
– The Provider may accept certain insurance plans. It is the Client’s responsibility to verify coverage.
– The Client is responsible for any fees not covered by insurance.
8. **Emergencies**
– The Provider does not offer emergency services. In case of a mental health emergency, Clients should contact emergency services or go to the nearest emergency room.
9. **Communication**
– The Provider may be contacted during business hours for non-urgent matters. Contact methods include text messages or direct calls.
– The Provider will respond to communications within 24 hrs.
10. **Termination of Services**
– Either party may terminate services at any time. The Client will be responsible for payment of any services rendered up to the point of termination.
– The Provider may terminate services if the Client fails to comply with these Terms and Conditions or for other professional reasons.
11. **Client Responsibilities**
– The Client agrees to actively participate in their treatment.
– The Client must provide accurate and complete information to the Provider.
12. **Privacy Policy**
– The Provider complies with all applicable privacy laws regarding the handling of personal and health information.
– A detailed privacy policy is available upon request.
13. **Dispute Resolution**
– Any disputes arising from these Terms and Conditions shall be resolved through mediation before resorting to litigation.
14. **Changes to Terms and Conditions**
– The Provider reserves the right to update these Terms and Conditions. Clients will be notified of any changes.
15. **Governing Law**
– These Terms and Conditions shall be governed by the laws of State of Indiana law.
Acknowledgment
By engaging the services of Passionate Behavioral Health Services the Client acknowledges that they have read, understood, and agree to these Terms and Conditions.
### Signatures
__________________________
Client Name
__________________________
Client Signature
__________________________
Date
__________________________
Provider Name
__________________________
Provider Signature
__________________________
Date
__________________________
© 2024 – Passionate Behavioral Health Services – Maintained by WonderWrks