Consent to Treatment
By signing this form I am consenting to treatment by Life Transitions Counseling, PLLC.
If an insurance company is being billed for your sessions, I am required to give a diagnosis to the insurance company in order for the sessions to be covered. You are welcome to ask at any time about the diagnosis being used in billing your insurance company.
By opting to bill your insurance provider for your sessions, you are consenting to information about you being shared with the insurance provider. This information includes the dates that you see me, the purpose of the visit, and a diagnosis.
Life Transitions Counseling, PLLC. Policies
1. Session Length, Fees & Formats
All sessions last 53-60 minutes depending on the nature of the session. The self-pay fee per session for any new clients is $275 payable on the date of service via Zelle. Effective July 1, 2026, the fee for existing clients will be $275. All insurance co-pays and or deductibles are due at the end of each session payable by Zelle. All Zelle payments should be sent on the Zelle app to debraalper1@gmail.com. All sessions will be conducted as telehealth sessions.
2. Cancellation Framework
48-hour notice of cancellation is required. If notice is not given, you will be charged for the session.
3. Confidentiality & Legal Exceptions
The content of all sessions is completely confidential unless permission is given to disclose any information regarding our work together. The only exception to this is if in my clinical judgment you pose a threat of harm to self or others, or if I should learn of any abuse to children or the elderly. By law, I am then required to get help for you, or the person who is in danger of being harmed or has been harmedNormally I can help with things like this, but I don’t seem to have access to that content. You can try again or ask me for something else.
