• Email hapsychology@gmail.com
  • Phone (040) 2784 7755

INFORMED CONSENT FORM

Information about the counselor/ adult client contract

Welcome to the HAP practice.  This document contains important information about our professional services and business policies.  Please read it carefully and jot down any questions you might have so that you can discuss them at your next meeting with your counselor.  This document represents an agreement between you and your counselor at HAP, so kindly read it before you complete the client registration form as when you complete that form, you had to tick that you read this form and understood it. Thanks!

PSYCHOLOGICAL SERVICES

Counseling is not easily described in general statements.  It varies depending on the personalities of the counselor/psychologist and client, and the particular problems you hope to address.  There are many different methods we may use to deal with those problems.  Counseling is not like a medical doctor visit.  Instead, it calls for a very active effort on your part.  In order for the counseling to be most successful, you will have to work on things you discuss with your counselor during your sessions and at home.

Counseling can have benefits and risks.  Because counseling often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. However, you will have your counselor support you through these unpleasant feelings. On the other hand, counseling has also been shown to have benefits for people who go through it.  Counseling often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress.  But, there are no guarantees as to what you will experience.

Our first session will involve an evaluation of your needs and this will continue throughout the process of counseling.  By the end of the first session, the counselor will offer you a preliminary or first impression of what your work will include and a general plan to follow, if you decide to continue with counseling.  You should evaluate this information along with your own opinions about whether you feel comfortable working with the counselor. If at any time the counselor believes that she/he is not the right counselor for you, he/she will let you know the same and, if so, will give you referrals to other practitioners whom we believe are better suited to help you. 

Counseling involves a large commitment of time, money, and energy, so you should be very careful about the counselor you select.  If you have questions about any procedures, please discuss them with your counselor whenever they arise.  If your doubts persist after you begin counseling and you don't feel like your counselor is a good fit for you, we will be happy to help you set up a meeting with another mental health professional for a second opinion.

About Counseling at HAP:

HAP utilizes a short-term model of counseling which focuses on helping you clarify your concerns and work towards the resolution of difficulties. Individual counseling sessions are 50 minutes in duration and scheduled with a specific counselor. The frequency and total number of sessions are determined by clinical need and HAP policies.  Counseling is provided by trained psychologists, counselors and advanced counseling psychology trainees who work under close supervision of our senior staff. 

You and your counselor will discuss counseling goals, which may include referrals to psychiatric services or other forms of treatment for comprehensive care. For a higher level of care, HAP will provide you with referrals to other clinicians who are specialized in the specific services you need or are able to provide you with the high level of support you require that might not be possible at HAP.

APPOINTMENTS, CANCELLATIONS & RESCHEDULING SESSIONS

We normally conduct a pre-screening to decide if our agency is suited to meet your needs. If we agree to begin counseling, the appointment will be a 50-minute appointment per session (50 min appointment hour) that we schedule, at a time we agree on, although some sessions may be longer or more frequent. 

Once an appointment hour is scheduled for the first session, you will be expected to FIRST COMPLETE PAPERWORK and then PAY within a specified timeframe or the appointment automatically stands cancelled. We will inform you of the timeline by which payment has to be completed. Once you have completed the paperwork and the payment in time, the appt stands confirmed. If you complete one or the other (either paperwork or payment) but not both within the specified time frame, please note that the appt will stand cancelled automatically. In such situations, if you have paid (without completing paperwork) and request a refund, we will charge you Rs. 300/- processing fee for processing your refund each time.

You can cancel and reschedule the appt with 24 hours advance notice of cancellation. All appointments cancelled or rescheduled with less than 24 hours notice will be charged fully and no refund will be provided. If both counselor and client agree that you were unable to attend due to circumstances beyond your control, then the fee is not charged. Please note that we strictly follow the 24 hour rule for cancellation/rescheduling and will charge for that appointment. Please note that we do not remind you about your appts once they have been scheduled and it is your responsibility to attend the appt or let us know otherwise.

In order for appts (after the first appt) to be confirmed, payments have to completed at the time of making the appt AND a screenshot has to be sent to +91 9493975140 via WhatsApp.

If we do not receive the payment AND screenshot of the payment, we cannot guarantee a confirmed slot. Once we receive both payment and screenshot only can we confirm the slot for you and you will receive a confirmation message via WhatsApp. This policy will be applied to all appts henceforth and no exceptions will be allowed. Kindly cooperate with us and follow our policy.

We have limited slots and if we have a last min cancellation we cannot fill the slot, so we request payment at the time of making the appt to confirm your slot. If you do not wish to pay immediately, you can call us back when you want a slot and we will tell you the availability at that time. This allows us to offer the open slots to clients who are requesting appts. Thanks for your cooperation.

For refunds: Please note that for all refunds we typically will charge a processing fee of Rs.300/- per refund.

EAP appointments: If you are coming to us from an EAP service through your organization/school/college, then you are not charged for appointments. However, we consider it your responsibility to inform us if you will not be able to attend a session or if you need to reschedule the session. The same 24-hour advance cancellation policy (described above) applies to cancellations and rescheduling appointments. Please note that if you miss a scheduled appointment without proper cancellation (no show or cancel with less than 24 hour notice), we will not be able to reschedule that appointment unless a payment of Rs. 2000/- is made for the missed appointment. This fee will be charged to you to reschedule the appointment and you will be responsible for paying it prior to making another appointment. You will still be able to access free counseling services through your company when you reschedule appointments, after paying for the missed appointment. If you miss an appointment and request for another appointment for the same person (career, individual, testing, couples, group) the same policy applies.

Timelines: Please try to be on time for your appointments to make the most use of your time with your clinician. If you are running late, please contact HAP via phone with an approximate arrival time. If you arrive more than 15 minutes late for a counseling session, there may not be sufficient time for a productive session and the appointment may be cancelled and charged at our full rate. Please note that we always bill for full sessions, even if you are late. If we do not hear from you and you do not show for a session, the counselor will wait 20 min and then leave the session (for online meetings). For in person meetings, the counselor will not wait for more than twenty minutes after the scheduled start time.

If you are uncertain about anything regarding your appt, please call us or whatsapp us so can you assist you. Please note that if you miss an appt and call us several hours/days later stating you didn't know how to access a link, etc, it will be considered a no show and you will be responsible for the full fee for that session.

REQUIREMENTS: Kindly note that for counseling to be effective, you will need to be in a quiet space/room with privacy where you cannot be heard and/or seen by others. If you are in a space where you are around others (public place, room with other people around, etc), you counselor will not be able to continue the session and your appt will have to be cancelled and/or rescheduled. In such situations, it is your responsibility to ensure you are in a environment that is suitable to you where confidentiality and freely being able to talk are possible. We will not be able to provide you counseling services if that is not the case and we will be willing to reschedule your session once for no fee (at the discretion of the counselor). After that you will be charged the full fee for the session if the counselor had to cancel for this reason.

APPOINTMENT LINKS FOR ONLINE APPTS:

We send you the link for the first session after the paperwork and/or payment is completed. Please note that the link is the same and it to be used for all subsequent sessions.

PROFESSIONAL FEES

Our hourly fee for the 50 min hour ranges from Rs. 500/- to Rs. 6000/- per session of individual counseling. Couples Counseling is typically an 85 min session and fees range from Rs. 2500/- to Rs. 8000/- per session. Session charges depend on the counselor you see and this information would have been shared with you when you called for an appt.  If you meet more than the usual time, we will charge accordingly.  In addition to regular counseling appointments, we charge this same hourly rate for other professional services you may need, though we will prorate the hourly cost if we work for periods of less than one hour.  Other professional services include report writing, telephone conversations lasting longer than ten minutes, attendance at meetings with other professionals you have authorized, preparation of treatment summaries, and the time spent performing any other service you may request of us. 

BILLING AND PAYMENTS

You will be expected to pay for each session at the time of scheduling the appointment, unless we agree otherwise. Payment schedules for other professional services will be agreed to when such services are requested. 

CONTACTING COUNSELORS

If you need to call your counselor for any reason, please note that the counselor is often not immediately available by telephone.  Counselors do not answer the phone when we are with a client.  We will make every effort to return your call on the same day you make it, with the exception of weekends and holidays, however, it might not always be possible to call you back immediately.  If you are difficult to reach, please inform us of some times when you will be available.  If you are unable to reach us and feel that you cannot wait for us to return your call, contact your family physician or the nearest emergency room and ask for the psychologist/psychiatrist on call.  If the counselor will be unavailable for an extended time, he/she will provide you with the name of a colleague to contact, if necessary.

ELECTRONIC COMMUNICATION POLICY

In order to maintain clarity regarding our use of electronic modes of communication during your treatment, we have prepared the following policy. This is because the use of various types of electronic communications is common in our society, and many individuals believe this is the preferred method of communication with others, whether their relationships are social or professional. Many of these common modes of communication, however, put your privacy at risk and can be inconsistent with the law and with the standards of my profession. Consequently, this policy has been prepared to assure the security and confidentiality of your treatment and to assure that it is consistent with ethics and the law.

If you have any questions about this policy, please feel free to discuss this with HAP.

Email Communications

We use email communication and text messaging only with your permission and only for administrative purposes unless we have made another agreement. That means that email exchanges and text messages with the HAP office should be limited to things like setting and changing appointments, billing matters and other related issues.  Please do not email us about clinical matters because email is not a secure way of contact. If you need to discuss a clinical matter with us, please feel free to call your counselor so you can discuss it on the phone or wait so you can discuss it during your counseling session. The telephone or face-to-face context simply is much more secure as a mode of communication.

Text Messaging

Because text messaging is a very unsecure and impersonal mode of communication, we do not text message to nor do we respond to text messages from anyone in treatment. .  So, please do not text message us unless we have made other arrangements.

Social Media

Our counselors do not communicate with, or contact, any of our clients through social media platforms like Twitter and Facebook.  In addition, if a counselor discovers that they have accidentally established an online relationship with you, he/she will cancel that relationship.  This is because these types of casual social contacts can create significant security risks for you.

Our counselors participate on various social networks, but not in our professional capacity. If you have an online presence, there is a possibility that you may encounter your counselor  by accident. If that occurs, please discuss it with your counselor  during our time together.  We believe that any communications with clients online has a high potential to compromise the professional relationship. In addition, please do not try to contact your counselor in this way. Our counselors will not respond and will terminate any online contact no matter how accidental.

Websites

We have a website that you are free to access. We use it for professional reasons to provide information to others about  our counselors and our practice. You are welcome to access and review the information that we have on our website and, if you have questions about it, we should discuss this during your counseling sessions.

Web Searches

We will not use web searches to gather information about you without your permission. We believe that this violates your privacy rights; however, we understand that you might choose to gather information about us in this way. In this day and age there is an incredible amount of information available about individuals on the internet, much of which may actually be known to that person and some of which may be inaccurate or unknown. If you encounter any information about us through web searches, or in any other fashion for that matter, please discuss this with us during our time together so that we can deal with it and its potential impact on your treatment.

Recently it has become fashionable for clients to review their health care provider on various websites. Unfortunately, mental health professionals cannot respond to such comments and related errors because of confidentiality restrictions. If you encounter such reviews of us or any professional with whom you are working, please share it with us so we can discuss it and its potential impact on your counseling. Please do not rate our work with you while we are in treatment together on any of these websites. This is because it has a significant potential to damage our ability to work together.

CONFIDENTIALITY [for adult clients]

In general, all communications between a client and a counselor/psychologist stays confidential, and we can only release information about your work with the counselor to others with your written or verbal permission.  But there are a few exceptions.

There are some situations in which your counselor is ethically and/or legally obligated to take action to protect others from harm, even if she/he has to reveal some information about a client's treatment.  For example, if the counselor believes that a child [elderly person or disabled person] is being abused or has been abused, he/she is required to make a report to the appropriate law enforcement agency in India.
If your counselor believes that a client is threatening serious bodily harm to another, he/she may be required to take protective actions.  These actions may include notifying the potential victim, contacting the police, or seeking hospitalization for the client.  If the client threatens to harm himself/herself, the counselor may be obligated to contact family members or others who can help provide protection.  If a similar situation occurs in the course of your counseling work, we will attempt to fully discuss it with you before taking any action. Typically, we try to seek the help of family members/friends in keeping a client safe but we can also seek hospitalization for him/her through calling the appropriate law enforcement agency/personnel.

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

Although this written summary of exceptions to confidentiality is intended to inform you about potential issues that could arise, it is important that you discuss any questions or concerns that you may have at your next counseling appt. Your counselor will be happy to discuss these issues with you and provide clarification when possible.  However, if you need specific clarification or advice on this area that your counselor is unable to provide, formal legal advice may be needed and as we are not lawyers, we cannot give you legal advice.

SUPERVISION OF COUNSELORS:

At HAP, we believe in continuing our education at all levels as counselors, and thus all our counselors undergo supervision. Supervision is a process where the counselor discusses his/her client cases with a supervisor who helps them better serve the clients they see. It is important for you to understand your counseling process will be overseen by both HAP's Director Dr. Diana Monteiro (Ph.D., Counseling Psychologist) and their internal individual supervisor at HAP. This means that your case will be discussed by your counselor and supervisor from time to time and you will not be informed of these discussions.  By signing this contract you agree to the oversight of your counseling process and clinical files as per our internal processes at HAP. Supervisors are bound to the ethical and legal guidelines of confidentiality and no information is shared with anyone outside of our office without your permission.

The above form was adapted for HAP's use and was originally obtained from https://parma.trustinsurance.com/Resource-Center/Document-Library