Policies and Intake Forms

To sign up for classes, download Cates Intake Forms please return through Fax,email, Post, including signed policy sheet, thanking you.

Alternatively, Click here to Submit Online!

This agreement contains specific information that is important to understand and agree to as follows:

A commitment on the part of the client/student is essential to achieve the goals established by themselves and the practitioner. When the student/client actively takes responsibility for progress in treatment by practicing with awareness, discussing with the practitioner any and all difficulties that may arise in the process, surity in progress is probable.

PAYMENT OF FEES:

Theclient/student is totally responsible for the payment of any and all fees at the time of the delivery of services. In general the office does not do billing perse, however, many students do receive reimbursement from their insurance companies.The client/student assumes responsibility for any co-payment or services not reimbursed by insurance.

If a billing letter becomes necessary, a late charge of $50.00 is added to accounts not paid in full within 10 days, as well as an interest charge of 2% per month or 24% per year will be applied to any unpaid balances.
Cancellations without 48 hours notice are subject to a 50.00 fee,however for the first time, this can applied towards rescheduling within 2 weeks if paid at time of missed visit. Otherwise the missed appointment fee is simply a small partial payment of the fee lost in missed appointment.
IN THE EVENT OF ANY COLLECTION ACTIONS, THE Client/Student AGREES TO PAY ANY AND ALL COSTS ASSOCIATED WITH SUCH ACTION INCLUDING ATTORNEY FEES.

A fee of $35.00 shall be charged on all returned checks. Make sure that you have suffieient funds to cover your check, as a penalty of up to five times the amount of the check may be assessed by the courts.

PATIENT CONFIDENTIALITY: absolute confidentiality will be maintained by the therapist regarding the contents of your sessions. Patient/therapist privilege is protected by federal and state law. A release of information must be signed by you if you wish for information about your treatment to be released to anyone.

CONFIDENTIALITY EXCEPTIONS:

No confidentiality exists in cases of suspected child, spousal, sibling or elder abuse.

No confidentiality exists in cases where suicide threats or threats of violence against another person are made.

State law mandates that law enforcement agencies and any threatened persons be notified immediately.

No confidentiality exists regarding the collection of fees.

FEE SCHEDULE:

Diagnostic Evaluation (1.5 hours, includes lesson)…………….……………$225.00

Office Visit (half hour) …………………………………………….. ……$75.00

Office Visit   (one hour) …………………………………………….. ……$150.00

Home Visit  – travel time extra  )………………………………………………$150/ hr

Overtime (prorated) ……………………………………………………….$37.50/ 15 min

After-hours Emergencies, Home or Hospital Visits, and Telephone Calls: $50.00 per 15 min after hours payable just prior to phonecall with paypal

(after 5 p.m. and weekends)

Narrative Reports…………………………………………………………..$100/ page

Court Appearances…………………………………………………………$1500.00

Phonecalls to providers, research, correspondence with Physicians or other providers , ……………………………..$40.00 per ½ hr

A Brief Initial Telephone consultation is included in the cost of the first visit. Thereafter, 15-Minute Telephone Consultations are available for 50.00 each. A scheduled appointment and advance payment is required for all telephone consultations, except in emergencies, whereby there is a 50.00 minimum. Thank You very much for your consideration in observing these customary procedures.
Signed ______________________________________________________________ Date ____________________

  1. KATHY’s avatar

    Is there a schedule of on-going classes?

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