OUTPATIENT SERVICES CONTRACT
Welcome to my practice: Mike Nordquist Counseling Thank you for considering working with me. This document contains important information about my professional services and business policies. Please read it carefully and make note of any questions you might have so that we can discuss them. When you sign this document, it will represent an agreement between us.

PSYCHOLOGICAL SERVICES
Psychotherapy varies depending on the personalities of the therapist and patient, and the particular issues you hope to address. There are many different methods I may use to deal with those problems. Psychotherapy calls for a very active effort on your part. In order for the therapy to be most successful, you may have to work on things we talk about both during our sessions and at home.

I promote myself as a Catholic therapist. Though I don't strictly see Catholic patients, my worldview is of a practicing Catholic, and I incorporate that perspective in my counseling. That being said, if you would prefer faith not play a major role in our work together, that is something I am sensitive to, and can adjust my approach.

Though I am from the diocese of Rochester, New York, I am not working for the diocese. My practice is completely independent of the diocese of Rochester.

Psychotherapy can have benefits and risks. Because therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. On the other hand, psychotherapy has also been shown to have benefits for people who go through it. Therapy often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress.

Many times, people of faith can feel disappointed by healthcare in the secular world. Given the demand for faith-based therapy, I seek to provide a bridge between the mind and the soul. There are mental health issues that can arise from sin, but not necessarily so. Though different from pastoral counseling, part of our work together will involve parsing through these distinctions, and discussing what your needs are and how you can be best served.

Our first session or two will involve an intake. In this meeting I hope to learn more about you, what your goals are, and answer any questions you have about me or therapy itself.

MEETINGS
After the intake, if we agree to begin psychotherapy, I will usually schedule one [50 minute] session every two weeks, at a time we agree on, given my available time slots. Appointments can be more frequent or less frequent depending on your needs and therapist availability. If you cannot make it to an appointment, please let Mike know at least 24 hours in advance if possible. You will not be charged for missed appointments.

PROFESSIONAL FEES
My hourly fee is $150.00. This fee is the same for intake as well as any follow up session. Please let Mike know if obstacles arise in regard to payment. I am not paneled for insurance at this time, but I can provide a superbill upon request if you wish to see if insurance will reimburse you for an out-of-network service.

BILLING AND PAYMENTS
You will be expected to pay for each session at the time it is held, unless we agree otherwise. In circumstances of unusual financial hardship, I may be willing to negotiate a fee adjustment (with a reduced session time) or scheduling change in order to mitigate this issue.

If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, I have the option of using legal means to secure the payment. This may involve hiring a collection agency or going through small claims court. [If such legal action is necessary, its costs will be included in the claim.] In most collection situations, the only information I will release regarding a patient's treatment is his/her name, the dates, times, and nature of services provided, and the amount due.

CONTACTING ME
I am often not immediately available by telephone. When I am unavailable, my telephone is answered by an answering service [voice mail] that I monitor frequently. I will make every effort to return your call on the same day you make it, with the exception of weekends and holidays. If you are difficult to reach, please inform me of some times when you will be available. If you are unable to reach me and feel that you cannot wait for me to return your call, contact your family physician or the nearest emergency room and ask for the psychologist [psychiatrist] on call. If I will be unavailable for an extended time, I will let you know ahead of time. You can also send a message through the Counsol software. Finally, feel free to send me an email at nordquistcounseling@gmail.com. I will be the only person having access to and checking this account, as well as any messages on Counsol, or voicemail.

CONFIDENTIALITY [for adult patients]
In general, the privacy of all communications between a patient and a therapist is protected by law, and I can only release information about our work to others with your written permission, but there are a few exceptions.

In most legal proceedings, you have the right to prevent me from providing any information about your treatment. In some legal proceedings, a judge may order my testimony if he/she determines that the issues demand it, and I must comply with that court order.

There are some situations in which I am legally obligated to take action to protect others from harm, even if I have to reveal some information about a patient's treatment. For example, if I believe that a child [elderly person or disabled person] is being abused or has been abused, I must make a report to the appropriate state agency.

If I believe that a patient is a danger to oneself or others, I am required to take protective actions. These actions may include notifying the potential victim, contacting the police, or seeking hospitalization for the patient. If a patient voices suicidal ideation to the therapist, a suicide assessment and safety plan will be completed if appropriate.

I may occasionally find it helpful to consult other professionals about a case. During a consultation, I make every effort to avoid revealing the identity of my patient. The consultant is also legally bound to keep the information confidential. Ordinarily, I will not tell you about these consultations unless I believe that it is important to our work together.

Your signature below indicates that you have read the information in this document and agree to abide by its terms during our professional relationship.