If you have questions about the therapy process, then please feel free to ask. If you don’t feel comfortable playing on the floor then please just tell me because we may be able to use someone else in your family to do this work (e.g., an older sibling, a grandparent, an aunt or uncle). If you are not seeing progress or you disagree with my approach to therapy, then if I can make some changes then I will but I am also willing to refer you to another psychologist or counselor. Since my office is located in a professional building and not a psychological or psychiatric facility – you must dress appropriately and your child must behave appropriately. This means that if your child cannot participate in sessions without getting out of control or becoming very loud or destructive then we may not be able to do therapy in my office because of the rules governing the use of my office. We can explore other options such as teletherapy where we do therapy over a secure electronic device.

I sometimes meet with older children or adolescents in my office alone if there are special circumstances that indicate that approach is best. Although they do not legally have a right to privacy – some confidentiality is needed for the patient to open-up.

Confidentiality

All of the information gathered about your child or adolescent (including the fact that they are in therapy) is private and confidential. This means that as your child’s psychologist, I cannot share with anyone any information about your child without your express written permission. However, the law has some exceptions to this rule of confidentiality.

• If you use insurance to help pay for your child’s therapy, then I must release some information before they will pay their part. Usually, this just involves the diagnosis, but some insurance companies want more clinical information. By signing this form – you are giving me information to release this information.
• I may communicate with your child’s pediatrician, primary care physician or prescribing physician if your child is on psychotropic medication (medication for psychological reasons). By signing this form – you are giving me permission to communicate with that physician.
• If I become convinced by what you or your child say that it is likely that your child is being physically, sexually or severely emotionally abused – then I am required by law to notify Child Welfare Services. I would not do so without talking to you first to better understand the situation and if my opinion is not changed then I would give you an opportunity to make the call to Child Welfare Services. This principle applies to anyone who participates in therapy with your child (e.g., a sibling, the child’s other parent, your spouse).
• If I become convinced by what you or your child say that it is likely that your child is physically, sexually or severely emotionally abusing another child then I am required by law to notify Child Welfare Services. This obviously applies to older children who clearly know right from wrong. I would not do so without talking to you first to better understand the situation but if my opinion is not changed then I would give you the opportunity to make this call to Child Welfare Services.
• If you become involved in the court system for some reason, then the judge may order me to release records or testify. If this is a matter of the custody of your child – I can only speak to what the child says, feels or thinks. If I receive a subpoena from an attorney from one of the parents, then I reserve the right to try to quash the subpoena if I think my participation in the legal proceedings would harm your child. This may involve charges to you since I have to cancel hours with other patients in order to be present at court. Since testifying is not a psychological service the charges cannot be filed with insurance companies.

Treatment of Children of Separated or Divorced Parents

In the treatment of children whose parents are divorced or separated, a number of issues sometimes arise. By signing this document, you have identified that you understand and are in agreement with the following policies:

• I may need a copy of your divorce decree – particularly with regard to custody and who is financially responsible for therapy or for maintaining insurance on the child or adolescent.
• Each parent can have time with this clinician and his/her child regardless of which parent initially contacts the clinician. The parent who brings the child is expected to provide contact information for the other parent. Exceptions to this include parents who live out of state; those who have no contact with their children or do not want to participate. I am available to consult by phone with parents that live out of state. Other exceptions include safety issues and the presence of restraining orders.
• I will not make recommendations regarding visitation or custody. I am not a forensic psychologist who is trained in this type of evaluation. Therefore, I will not communicate with attorneys for either parent. If I receive a subpoena that I cannot quash then my testimony will consistent of the mental health of my patients and not an evaluation of one or both parents.

Regarding disputes about the custody of your children. Always think about your kids and their interests first. Your child/children need both parents and their love. Divorce is a very stressful process for any kid. It is hard for them to understand that their parents do not love each other the way they did before. Often, children of divorced parents feel abandoned and might even blame themselves for their parents’ divorce. In order to help your children adjust easier to the new relationship between their parents, try your best to cooperate with your ex-spouse or partner in a civilized manner. Do not make derogatory or offensive comments about your ex-spouse and never argue with your ex-spouse or partner in front of your children. If a joint custody arrangement is possible, consider this option as the priority choice for your kids. It will allow your kids to see both parents often and get the love and support of both parents.

Law Dictionary: Tips for Child Custody Battles

PROFESSIONAL RECORDS: I am required to keep appropriate records of the psychological services that I provide. Some of your records are maintained electronically in my office, which has a locked door and in a building with a security system. However, I use an Electronic Medical Records system called TherapyAppointment.com and they store electronic records in highly secure system. I keep records noting that you & your child were here, your reasons for seeking therapy, the goals and progress we set for treatment, your child’s diagnosis, topics we discussed, your child’s medical, social, and treatment history, records I receive from other providers, copies of records I send to others, and your billing records. Except in unusual circumstances in which I am convinced that your child would be harmed by releasing his/her records, you have the right to a copy of your file. There are two types of information in your electronic chart – (1) Copies of billing tickets, reports written, correspondence or records received, documents you have completed and/or signed; and (2) My progress notes about our sessions in which I may record clinical impressions, statements you or your child make to me and information we have discussed during our session as well as comments about my treatment plan for your child and our progress in reaching goals.

Since the “progress notes” are written primarily for my benefit to keep in mind where we are in the therapy process – they may be misinterpreted and / or upsetting to untrained readers. For this reason, I may refuse a request for those records. I can have them forwarded to another medical professional if that is needed to coordinate treatment for the child. If I refuse your request for access to your child’s clinical records, you have a right to have my decision reviewed by another mental health professional, which I will discuss with you upon your request. You also have the right to request that a copy of your file be made available to any other health care provider at your written request.

Out-Of-Session Services

My emphasis is on being 100% available to you during your sessions. Contacting me outside of sessions is discouraged but occasionally communication is possible if you have an urgent situation. However, for information about appointments or general information – you will need to communicate with one of my secretaries. They will ask me questions if they do not have the answer and will return your call with a response. I would prefer that you contact me through email at dr.garyjones@protonmail.com. Email is generally not considered a secure avenue of communication so you should be cautious about communicating confidential information. I use Proton Mail because it allows emails to be encrypted and is the most secure email service available. If you need to communicate confidential information by email then you can set up a free email account with https://protonmail.com and send a message to me. Proton Mail can encrypt messages when they are sent.

My office phone number is answered 24 hours a day / 7 days a week. Office hours (8:30 am to 5:00 pm) Monday through Friday except for holidays one of my secretaries will answer your call. If they are not available or the office is closed then an answering service handles the call and they will send me a secure text within 15 minutes of you leaving the message. However, I do not take calls from 9:00 pm to 7:00 am so do not expect a call during the night. If it is an emergency, then you need to call 911 or go to a local emergency room. Cell phone communication is not a HIPAA Secure form of communication so if you don’t want to take that risk then tell me to only call you from my office phone.

However, if this is an EMERGENCY SITUATION DO NOT CALL ME. There are several resources…

• Call 911 and explain your emergency to them.
• Go to the nearest Emergency Room and explain your emergency.
• Go to or call a local psychiatric hospitals:
  • Parkside Psychiatric Hospital, 1620 East 12th Street, Tulsa, OK 74120  Phone: 918-588-8888
• Family & Children’s Services has a crisis phone line on their website (918-921-3200).
• COPES is an organization that can provide support in crisis situations & their #918-744-4800.
• There are two parent hotlines that can help (though I have only read their websites)…
  • National Parent Helpline 1-855-427-2736 is available 24 hours a day.
  • Parental Stress Line 1-800-632-8188 is available 24 hours a day.

Fees For Services

Fees for psychotherapy services are due at the end of your appointment time. If I am not a provider for your insurance, then I can provide you with a copy of the invoice showing what you paid with the appropriate CPT codes for you to submit to your insurance company. If your insurance company will not reimburse you, I can often refer you to a colleague who is a provider for your insurance company. The fees for my services are as follows

• Therapy: Psychotherapy 45-50 minutes = $125 & Psychotherapy 60-70 minutes = $165
• Testing:Psychological or Neuropsychological Testing =$155 per hour and generally it takes as many hours to write up the report as it takes to do the testing. Insurance Companies are typically very reluctant to pay for testing or they will authorize a fraction of the time required to provide this service. It is important for you to know that if the testing has anything to do with school then the testing is almost never classified as a covered benefit. Consequently, many people cannot afford testing because for any significant problem – the testing will take 8 hours. This could add up to $1000 to $1500.
• >Court Testimony:Testimony, court appearances, preparation of written documents, meetings, and phone consultations for legal proceedings initiated by you or others relating to your case: $155.00 per hour. This is not a service covered by insurance.
• Attendance and Participation at an Individualized Education Program (IEP) Meeting:$125 per hour. Travel time that is within 15 minutes of my office is included. Time beyond that is charged at the proportionate hourly rate.

Payment For Services

Insurance is very difficult to predict because there are so many ways that they may deny payment: *Deductible hasn’t been met; *I am not a provider for your insurance company; *Mental health benefits are handled differently than what they call medical benefits; *They will classify certain psychological services as not eligible (e.g., testing related to learning is almost never covered); *Out of network providers sometimes have a separate deductible. Most people assume that their insurance is going to pay its part. Consequently, it is easy for your part of the cost to grow to several hundred dollars before we find out how your insurance is going to respond to our claims. So, unless your child is covered by Medicaid Insurance – it is very important for you to check with your insurance company and read your EOBs (Explanations Of Benefits).

If you are making your copay and are surprised by your insurance’s non-payment then I am willing to work with you to pay your balance. However, if you are unable to pay your part then we will have to make some arrangements to make services match your finances. We can reduce the frequency of sessions, reduce the length of sessions or I can refer you to another clinician who might be a provider for your insurance company. Also, there are Health Departments with counselors in what is called their Guidance Division. Their counselors are available for child ages 1-13 and charges are on a sliding scale. Family & Children’s Services also provides mental health services and from what I can tell there either no cost or minimal cost for their services.

In extreme situations during which you are making no payments I may utilize a collection service for unpaid balances on services rendered. All efforts will be made to resolve this issue without resorting to the utilization of this service, but if you are unresponsive to these efforts, a collection agency may be utilized. Understand that certain personal information will need to be disclosed to this agency.

Scheduling And Late Cancellation Policy

Sessions are typically scheduled regularly at the same time and day, if possible. Consistent attendance to therapy helps achieve the outcome you are seeking. In making an appointment, I am setting aside time for you. If you cannot attend your appointment, please CALL or TEXT me at least 24 hours before your appointment so that I can serve someone else that has been waiting for an appointment. 24 hours provides me with enough time to make other arrangements for that hour. If you do not notify me within 24 hours, a charge of $60 may be added to your account. The only exceptions to this are a medical emergency or some unforeseen event, like a family emergency or a car breaking down. Insurance does not reimburse for no-shows or late cancellations. Medicaid patients cannot be charged a No Show / Late Cancellation Fee but after missing two appointments without advance notice your child may be taken off my schedule.