Registration Form for
Deborah Lee APRN, CNS, CIMHP
Please complete and sign this registration form as much as possible or contact me with any questions. Thanks.
Policies and Agreements for Consultations with Deborah Lee
Welcome! Here is some important information about my holistic therapy and integrative mental health consulting practice. I view our work as a partnership formed to enhance your health and well-being. Please see my website, irisheal.com, for information on my credentials, fees, philosophy of care, privacy policy, medical disclaimer, and terms and services. Thanks.
CONFIDENTIALITY
The contents of all counseling sessions and your medical records are confidential. Your records can only be released with your written consent. Additionally, the law requires me to make a report in the following cases: intention to harm oneself or another person or suspected abuse to another person.
IMPORTANT TELEHEALTH SERVICES INFORMATION
According to the standards for telehealth services, I am unable to work with you if you have any current or past thoughts of suicide, are self-harming, have a severe mental health condition, or have any active alcohol or substance abuse addictions. These policies are in place because it is best to have local providers in these circumstances. You are required to be in a safe, private location during the consultation. It is standard not to communicate via social networks and to limit texting and email to non-clinical information. If you forget or choose to do so, you accept full responsibility for exposing your personal information in this way. I will respond by asking you to call me. This is for your protection and safety.
CANCELLATION POLICY
If you need to reschedule or cancel an appointment, please contact me at least 48 hours in advance. If less than 24 hour’s notice is given, you will be charged /$70 for the missed session, with some rare exceptions. Please call me (do not text or email) if you would like to discuss your circumstances and possibly avoid a late cancellation fee.
FINANCIAL POLICY
Please see my contact page for fee information. Clients are expected to pay at each session unless otherwise arranged. There is a $35 charge for all returned checks. If unpaid balances are not paid in 30 days and I need to go to collections, a 30% collection fee will be added to the balance.
EMERGENCIES
Please call 911 or go to your nearest ER if you need immediate attention. You may also contact the National Mental Health Hotline at 1-866-903-3787, the Suicide Prevention line at 988, or your local Crisis number.