Registration Form for Therapy with Deborah Lee
Please complete and sign this registration form or contact me with any questions or issues with the form. Thanks.
Policies and Agreements for Deborah Lee, APRN, CNS, CIMHP
Welcome! Here is some important information about my mental health and wellness therapy 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 and an overview of my 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 you give less than 24 hours notice, you will be billed $70 for the missed session if you do not call (do not text) to discuss your circumstances.
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 for 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.