Welcome to Chandler Therapy. The information below is intended to inform you about office policies and procedures. Because your relationship with your therapist is based on confidence and trust, it is important that you be fully informed of some of the key elements of that relationship. Please be assured your therapist is ready and willing to discuss these issues in detail if you have any questions or concerns. Please ask for clarification on any of the information contained in this document if unclear to you. This form also serves to document that these issues have been addressed.

Chandler Graduated with a Master's of Science in Clinical Mental Health from The University of St. Thomas. Their program upholds the highest standards of ethical, legal, and professional conduct; evidence-based clinical practice; social and cultural diversity; social justice and the dignity of all persons. She went on to obtain professional credentialing as a Licensed Professional Counselor by the Texas State Board of Examiners of Professional Counselors. Chandler continues to emphasize training and research as tools to inform treatment. She has experience and training in Cognitive Behavioral Therapy, as well as Trauma Focused CBT. Chandler regularly engages in continued education and trainings to better serve her clients.

Emergencies: The office number is 713-487-8147. If you have an emergency and cannot reach Chandler at this number, please call her personal phone number at 979-820-4382. Please go to the nearest emergency room if you are experiencing a life-threatening emergency.

Goals of Therapy: Goals of treatment will be developed in discussion between Chandler Garza and the client/family. Therapy is a joint effort between the therapist and client, the results of which results cannot be guaranteed. Progress depends on many factors including motivation, effort and other life circumstances such as interactions with family, friends and other associates.

Risk of Treatment: Talking about sensitive problems can sometimes make one become more anxious and/or depressed. However, this feeling tends to be temporary and decrease as you become more familiar with your therapist and progress through treatment. Only a minority feels their condition worsens as a result of treatment.

Length of Treatment: The length of treatment will be determined in discussion between Chandler Garza and the client. You may withdraw from treatment at any time. If you elect to stop therapy, Chandler can provide you with referrals to other clinicians to continue care. Clients must physically be in the state of Texas during session time to receive tele-therapy services

Appointment Times: Psychotherapy sessions are 50-55 minutes in length, and all sessions must begin within 15 minutes of the appointment time. Appointment times are limited. Each session is 50 minutes unless a second session is requested to extend time. Office hours and availability are located in the CounSol client portal for reference. Generally, clients are seen between 11am and 5pm. If you are unable to keep your appointment, please contact Chandler within 24 hours of your appointment time. Since your appointment time is reserved for you, appointments not cancelled with 24 hours' notice will be charged the regular hourly rate of $150.

Payment: Payment is expected at the time of treatment. If payment is not received within 30 days, the therapist reserves the right to terminate therapy. All clients are required to have a payment method on file to schedule a session. Credit Card is the only payment method accepted at this time. Individual session rates are $150/session, $560 for a package of 4 sessions, and $1040 for 8 sessions. A sliding scale is available for clients based on need.

I understand there will be no refunds on any prepaid visits. They have no expiration.

Refunds: There will be no refunds issued.  

Confidentiality: Clients must be in a private, quiet space when participating in tele-therapy sessions on the HIPAA compliant video platform. The information you provide to Chandler Garza is confidential and will only be released to others with your written consent. By law, Chandler is required to disclose confidential information, even without your consent, in certain circumstances. These circumstances include, but are not limited to the following: if you are a danger to yourself or others; if you are a minor, elderly, or have a disability and it is believed that you are a victim of abuse; if you report to Chandler that a previous helping professional engaged in a sexual relationship; if you file a suit against the therapist for breach of duty; and if a court order or other legal proceeding or statute requires disclosure. You have the opportunity to discuss with Chandler any questions you may have on the limits of confidentiality.

Court Ordered Therapy: Payments must be made in full as mandated by the court. Compliance or non-compliance will be all that is reported when time required is completed. You must arrive on time for your appointments. If you are late, please note that only 15 minutes will be allowed. If you are more than 15 minutes late, you will have to reschedule and be charged for the visit.

Consent for Treatment: I have read and understand this Client Information and Office Policies and Procedures, and I consent to treatment. I recognize that I have the opportunity to discuss any questions I may have with Chandler Garza.

1. I understand that my health care provider conducts treatment via telehealth services.

2. I understand that I must be physically in the state of Texas to receive telehealth services.

3. I understand that telehealth has potential benefits, including easier access to care and the convenience of meeting from a location of my choosing.

4. I understand there are potential risks to this technology, including interruptions, unauthorized access, and technical difficulties. I understand that my health care provider, or I can discontinue the telehealth consult/visit if it is felt that the video connections are not adequate for the situation.

5. I have had a direct conversation with my provider, during which I had the opportunity to ask questions in regard to this procedure. My questions have been answered and the risks, benefits and any practical alternatives have been discussed with me in a language in which I understand. 

Psychology Today's HIPAA compliant "Sessions" platform, Facetime, and Zoom are the technology services that we may use to conduct telehealth video appointments. They are simple to use, and there are no passwords required to log in. Sessions and Zoom requires a unique video link to access the session. Facetime must be accessed through the provider and client's unique phone numbers. By signing this document, I acknowledge:

1. Telehealth via the various platforms discussed above are NOT an Emergency Service and in the event of an emergency, I will use a phone to call 911.

2. I will enter session from an environment that is quite and private to ensure confidentiality.

3. To maintain confidentiality, I will not share any potential telehealth appointment links with anyone unauthorized to attend the appointment.

4. I understand that Chandler does not have extensive knowledge about beyond a provider's basic scope, and is not responsible for troubleshooting technical difficulties. I am responsible for stable internet connection and accessing the platform in a timely manner.

Chandler has the right to discontinue the telehealth consult/session if it is felt that telehealth platforms are not adequate for the situation, poor connection/technical difficulties, or a breach of any of these requirements.            

By signing this form, I certify:

* That I have read or had this form read and/or had this form explained to me.

* That I fully understand its contents including the risks and benefits of the procedure(s).

* That I have been given ample opportunity to ask questions and that any questions have been answered to my satisfaction. 

BY CONTINUING AND CLICKING THE SAVE BUTTON BELOW, I AM AGREEING THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.

Automated Notetaker

Your clinician has opted to use Blueprint's note-taking system as part of their effort to provide excellent care to clients. Blueprint's note-taker temporarily records sessions and uses this recording to automatically generate a progress note (a required form of clinical documentation). After a progress note is generated, the recording is automatically deleted from Blueprint's servers and database.

Use of this technology allows your therapist to be fully present during your sessions, without having to slow down to take notes or trying to remember important information during the session. This allows them to focus all of their attention on your care.

Blueprint's software is HIPAA compliant and SOC 2 Type 2 certified, which means an external third-party auditor reviews Blueprint's systems, policies, and processes on an ongoing annual basis to ensure Blueprint meets certain data privacy and security standards.

By signing this consent form, you are agreeing to allow your clinician to record your sessions and utilize software to assist them in generating progress notes to document these encounters.