Service Agreement
Effective Date: November 14, 2024
Written by Lisa Neff
Hello and welcome! This document contains important information about my professional services and business policies. By signing this document, you will be stating that you were provided with this information and it will represent a binding agreement between us. Your provider will review this with you to ensure your full understanding and answer any questions you may have.
Therapy Services
Therapy varies depending on the therapist, the client and the client’s particular situation and goals. There are many different methods which may be used to deal with a particular situation, goals, and objectives. For the best outcome, each client must choose to invest energy in the process and work actively on relevant topics both during and between sessions.
Therapy can have benefits and risks. The risks may include experiencing uncomfortable feelings like sadness, guilt, anger, anxiety or frustration when discussing aspects of life. Therapy has been shown to have benefits that can include better relationships, solutions to specific problems, increased life satisfaction, improved physical health, and significant reductions in feelings of distress. However, there are no guarantees as to what each client will experience. During our time in treatment or during the intake process it may come to my attention from a therapeutic standpoint a referral would be needed for a specialized type of therapy treatment. Often this occurs if I evaluate that a client would benefit from a specialty and/or a therapeutic intervention that I do not have training or experience in. If this does occur, I will discuss this with you and a referral to a different therapist would be provided.
What to Expect
The first few sessions will involve an evaluation of your situation including needs, goals, and objectives to work toward. Therapy can involve a significant investment of time, energy, and money. It is important to select a therapist with whom you are comfortable working. If at any time you have questions about therapy, please discuss them with me as they arise. If you decide to discontinue therapy, I will provide referrals to other therapists or other appropriate resources if requested.
Sessions
I schedule 53-minute sessions. If you arrive less than 15 minutes late for an appointment, the remaining time of our scheduled session is available to you. If you have not called or emailed me, I will not be available after 15 minutes from the scheduled start time and it will be considered a no-show appointment. The amount of times we meet (weekly, biweekly monthly) will vary depending on person to person and will be discussed and agreed upon together.
If you need to cancel a scheduled therapy session, you must do so at least 24-hours in advance. You can do this by emailing me at LisaNeff@NeffHW.com or our office at Admin@NeffHW.com. If you do not cancel a scheduled appointment with at least 24-hours notice, or if you fail to attend a scheduled session, you agree to pay the full fee for that session at $125, unless it is agreed upon that the absence was due to uncontrollable circumstances or a personal emergency.
Discharge of Client
After one no show session I will contact you to discuss the reason for the no-show appointment and rescheduling. If there are two back to back no show sessions I will not be contacting you to reschedule and will wait to hear from you. A client who no shows me three times in a row will be discharged and no longer considered an active client of mine. I am aware that life often gets in the way and things come up, but please communicate with me should this happen. Clients who do not make an attempt to schedule an appointment after a four week period will be discharged and will no longer be considered an active client of mine. I will always consider putting you pack on the schedule should this happen, but please be aware that availability is limited and you may be put on a wait list as a result.
Professional Fees
For private pay clients my fees run from $85-$150 an hour, which can be discussed and decided on an individual basis based on a client income sliding scale. In addition to regular sessions, it is policy to charge the therapy rate on a pro-rated basis for other professional services required. Other services include report writing, telephone conversations lasting longer than 15 minutes, consultations with other professionals which have been authorized, preparation of records or treatment summaries, and time spent performing any other professional service. Often, it is not helpful to participate in a legal process concerning any therapy that may have been given. Therefore, I will decline if asked to participate in any legal or court hearings. If it becomes necessary to participate, the rate for my preparation and participation in a court hearing or other legal proceeding will be $350 per hour. You will also be charged this rate for travel time, waiting time and agree to pay any additional necessary fees (for example, parking fees). Pre- payment of expected fees will be required one week (7 days) in advance of legal proceedings. You understand you will be billed for any remaining amount.
Billing and Payments
Payments may be made through SimplePractice, the online portal where virtual services are conducted. Payment schedules for other professional services will be agreed upon when/if they are requested. If your bill amount is over $150 I reserve the right to refuse service until the bill is paid in full. If a payment plan is necessary please let me know and we can work that out accordingly. If you have any questions regarding a bill or your insurance plan please contact Admin@NeffHW.com.
Contacting Me
Because I do not take calls during sessions, I may not be immediately available by telephone. Please contact me through the SimplePractice portal, email me or our office staff at LisaNeff@NeffHW.com or Admin@NeffHW.com. Every effort will be made to return calls within 24 hours, more promptly if possible.
If you are in an emergency situation, you can call:
OAKLAND COUNTY
Havenwyck Hospital
1-800-401-2727
WAYNE COUNTY
Henry Ford Kindswood Hospital (Ferndale)
248-398-3200
MACOMB COUNTY
Harbor Oaks Hospital
586-684-4574
LIVINGSTON COUNTY
Trinity Health Livingston Hospital
517-545-6000
MENTAL HEALTH CRISIS HOTLINE
Call or text 988
If you live outside of these four counties and feel a safety plan is needed where an inpatient facility is included please let me know during the creation of the safety plan.
You can also always contact local emergency services at 911, or call or go to the nearest hospital emergency room, telling them of your emergency. You understand that you are NOT to wait for me to return your call in an emergency situation. Please call me before to inform me, take yourself to the nearest above listed resource and then contact me once you have arrived or have staff notify me.
Social Media Policy
I do not interact or accept “friend” requests via social media sites (Facebook, TikTok, Instagram, etc) because it has the potential to compromise privacy and complicate our therapeutic relationship. I am also unable to be friends with any client past or present after any duration of time since it is against the code of ethics I abide by as a social worker and I am liable to lose my license.
Computer and email communications, while convenient, can be accessed by unauthorized individuals, potentially compromising privacy and confidentiality. Although my email system is encrypted and HIPAA compliant to safeguard your information, emails sent from your end may not be encrypted, and data theft could occur during transmission or on your email server. By choosing to communicate with me via email, you acknowledge and accept the potential risks of interception or unauthorized access to your information. I will honor your choice to communicate electronically and assume it reflects an informed decision to proceed despite these risks. You also agree that electronic communications become part of your medical record and that email should not be used for emergencies. Please note that computer or network issues may delay or prevent the delivery of electronic communications.
Professional Records
The laws and standards of the therapy profession require that treatment records are retained and kept for a period of 7 years after the last point of contact. You are entitled to examine and/or receive a copy of your record if requested in writing, unless it is believed that seeing the information would be emotionally damaging, in which case they will be sent to a mental health professional of your choice. Because these are professional records, they can be misinterpreted and/or upsetting to people who are not mental health professionals.
Confidentiality
In general, the law protects the privacy of all communication between a client and a mental health provider. I may only release information about your treatment to others if you sign a written authorization form. You may revoke any such authorizations at any time, which must be in writing. However, in the following situations, your authorization is not required to release your personal information:
• Therapist’s duty to warn another in the case of potential suicide, homicide or threat of imminent, serious harm to another individual.
• Therapist’s duty to report suspicion of abuse or neglect of children or vulnerable adults.
• Therapist’s duty to report prenatal exposure to any amount of alcohol, a controlled substance, or a metabolite of a control substance.
• Therapist’s duty to report the misconduct of mental health or health care professionals.
• Therapist’s duty to provide parents of minor children access to their child’s records, with some exceptions under Michigan law.
You also consent to the release of necessary billing and treatment information to Michigan Medical Billing Services, which provides administrative support for claims processing and insurance reimbursement. This release is limited to information necessary for the purposes of claims submission, insurance verification, and billing-related communications.
While we are not attorneys, please discuss any questions or concerns you have about confidentiality with us at any time by emailing our organization’s HIPAA officer at Admin@NeffHW.com. If you have specific legal questions about the laws regarding confidentiality, the exceptions, and how they may relate to your situation, please seek formal legal advice from an attorney.
Changes in Services or Fees
I, your provider (Lisa Neff), reserve the right to change the policies, practices, procedures, and fees described in this document. You will be notified within 30 days of any such changes.
Minors
If you are under 18 years of age, please be aware that the law may provide your parents with the right to examine your treatment records. It is my policy to request an agreement from your parents that they consent to give up access to your records. If they agree, I will provide them only with general information on how your treatment is proceeding as well as a summary of your treatment when it is complete. However, if I feel that there is a high risk that you will seriously harm yourself or another, I will notify them of my concern. Before giving your parents any information, I will discuss the matter with you.
Safety
I strive to provide a safe environment for all. Please let me know immediately if you have concerns for your safety during our treatment. If you are having thoughts or feelings of wanting to harm or kill yourself I urge you to share these in session.
Complaints & Feedback
If you have concerns about your care or believe your rights under state or federal law—including the Michigan Mental Health Code—have been violated, you may file a complaint with our office by emailing Admin@NeffHW.com or calling 734-770-9260. Complaints will be acknowledged within five business days and investigated promptly, with a written response provided within 30 calendar days. If you are not satisfied with the outcome, you may escalate your complaint by contacting the Michigan Department of Health and Human Services, the U.S. Department of Health and Human Services Office for Civil Rights, or the Michigan Board of Social Work, which licenses your provider as a Master of Social Work (MSW).
Attestation
[Before therapy begins, you will be asked to confirm your understanding of our service agreement. The following text is for you to review prior to your first session.]
By signing this document, you understand the basic goals, ideas, and methods of this therapy. You have no important questions or concerns that the therapist has not discussed with you. You understand that reaching the agreed upon therapy goal is not guaranteed. You understand that therapy is successful for some people, moderately successful for others, and for some not successful at all. You further understand that the initial symptoms or problems that were presented to the therapist may initially become more intense.
Moreover, you are agreeing to participate in individual therapy, while acknowledging that the course of therapy may change, and the participants may change, by agreement of all parties. You have received and read the information in this document, have discussed the contents with your therapist to your satisfaction, and agree to abide by its terms during the course of therapy. You understand you may request a copy of this document.