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Terms and Policy

CLIENT CONTRACT
This document contains important information about my professional services, my business policies and your legal rights. Please READ IT CAREFULLY and raise any questions you may have for discussion with Dr Leight via email before we begin your first visit. Once you sign this contract it will constitute a binding agreement between us.

PSYCHOTHERAPY SERVICES
You are requesting that Arlen Keith Leight, PhD, LLC provide individual, couples and/or group psychotherapy services. It is important that you understand several points about therapy.

Psychotherapy has been shown to have benefits for people who undertake it. It often leads to significant reduction of feelings of distress, better relationships and resolution of specific problems. However, the results of therapy CANNOT BE GUARENTEED. The outcome depends on many different variables including, but not limited to, the relationship you and I are able to form, our personalities, the nature of your past and current relationships, and your willingness to work actively both during and in between sessions.

There are certain risks associated with psychotherapy. These may include, but are not limited to, experiencing uncomfortable levels of feelings like sadness, guilt, anxiety, anger and frustration. Psychotherapy often requires facing unpleasant aspects of your life. I encourage you to discuss any concerns and feelings you may have as they arise.

PROFESSIONAL CREDENTIALS
Dr Arlen Keith Leight received a Bachelor of Arts in Psychology from The Johns Hopkins University and a Master of Social Work with a concentration in adult psychotherapy from The Catholic University of America. He received his psychodynamic psychotherapy training at The American University in Washington, DC. Dr Leight completed his sex therapy certification training from The American Academy of Clinical Sexologists at Maimonides University in Miami, FL, where he received his PhD in Clinical Sexology.
Dr Leight is currently licensed as an LCSW (Licensed Clinical Social Worker) in California (LCSW79108) Florida (SW6901), and an LICSW (Licensed Independent Clinical Social Worker) in Massachusetts (115188) and Washington, DC LC3000838). He is certified as a sex therapist and is a board certified clinical sexologist and a Diplomate of The American Board of Sexology. Dr Leight is also certified in clinical hypnotherapy and is recognized by the State of Florida as a clinical supervisor to provide training for intern therapists in pursuit of licensure. Dr Leight has been on the faculty of Florida Atlantic University, is currently an Assistant Professor at The American Academy of Clinical Sexologists, is professionally published and lectures extensively. His most recent publication, SEX HAPPENS: THE GAY MAN'S GUIDE TO CREATIVE INTIMACY, is considered THE resource for therapists working with gay male couples.

CONFIDENTIALITY

All communication during psychotherapy will be treated confidentially in accordance with law and recognized professional ethics and standards. However, there are some exceptions to confidentiality of which you must be aware:
1. If you sign a release of information, I am obligated to release specified information to the designated party.
2. If you are involved in a court case that involves child welfare your records can be subpoenaed.
3. If, in my professional opinion, you present a clear and imminent danger of doing bodily harm to yourself or another person I am obligated to take whatever "reasonable" steps are required to prevent that including notifying your relatives, designated emergency contact or police.
4. If you are a witness to or a victim of a crime the court could order your records.
5. If I have reason to believe that you or someone close to you is involved in child or elder abuse I must report this to Protective Services and the police.
6. When you sign your insurance form you are giving the insurance company the right to obtain information from me about such things as your diagnosis and the nature of your treatment. Receipts given to you to attach to your insurance form may have your diagnosis, treatment plan or other personal information.
7. If a claim is made against me in court or if a charge is disputed with a 3rd party, I may reveal information for the purposes of defending myself.
8. If you are involved in a court case where your mental condition is an issue, I may be required to testify or turn over records.
9. While there is no legal precedent, many experts believe that information shared either in group or couples therapy may not be protected in court proceedings.
10. Information about you may be shared in consultation with my clinical supervisor(s) or in group consultation with other licensed psychotherapists. A supervisor, by law, must also maintain confidentiality, except for the cases enumerated herein.
11. Any Skype video communication is considered secure, but cannot be guaranteed. Video communication between us is NEVER recorded and is kept confidential as per the parameters set herein.
12. Telephone communication is not considered secure, but all conversations are confidential as per the parameters set herein.
13. Email communication is not secure, but all correspondence is kept confidential as per the parameters set herein.
14. Any and all other disclosures required by law may represent a breach of confidentiality including but not limited to: disclosure for public health or safety; disclosure to military, national security, coroners, medical examiners or correctional institutions when required by law; disclosure for research when approved by institutional review board; disclosures for other court orders or lawful processes.

ACCEPTANCE
I have read and fully understand the contents of this document including the nature of the treatment as outlined above, the fact that results cannot be guaranteed, the limits of confidentiality in the relationship, and the circumstances under which that confidentiality may need to be legally violated.
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FEES AND FINANCIAL POLICY /CANCELATION POLICY
All psychotherapy sessions are 50 minutes in length. The fee is $165 per 50 minute session. Double sessions may be arranged in advance (100 minutes for $315), and are sometimes indicated for intensive work with individuals or couple counseling. Visits are paid through this secure site by VISA, MasterCard or American Express. A credit card must be registered prior to scheduling your first appointment.


The only insurance accepted is Medicare. If you have a non-Medicare PPO, Dr. Leight can provide a "superbill" receipt which you may use to file a claim with your insurance company for direct reimbursement to you. If you wish to use Medicare benefits you will need to provide your Medicare information to Dr. Leight prior to your first visit in order to determine eligibility before beginning therapy.  Dr. Leight does not participate in Medicare HMO or PPO plans.  If Medicare eligibility is confirmed, claims will be submitted by Dr. Leight after every 6 sessions or after your final visit at termination or after any 30 day break in therapy.  After the claim is paid, your credit card will be charged for any deductibles or copays as enumerated on the Medicare Explanation of Benefits.

Visits are generally scheduled on a weekly basis. You will schedule your own appointments in consultation with Dr. Leight's recommendations and availability. ALL cancellations or appointment changes for all clients, no matter the reason for the change, must be made at least 72 hours before the scheduled appointment to avoid being charged for the visit. By accepting these terms you are giving Dr. Leight permission to charge your card for each completed session as well as for any schedule changes without the required 72 hour notification.

ACCEPTANCE
I have read and fully understand and accept the financial terms including the cancellation policy.

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NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I am required by applicable federal and state law to maintain the privacy of your health information. I am also required to give you this Notice about my privacy practices, legal obligations, and your rights concerning your health information ("Protected Health Information" or "PHI"). I must follow the privacy practices that are described in this Notice (which may be amended from time to time). For more information about my privacy practices or for copies of this Notice please contact me.

I. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION

A. Permissible Uses and Disclosures Without Your Written Authorization
I may use and disclose PHI without your written authorization for certain purposes as described below. The examples provided in each category are not meant to be exhaustive, but instead are meant to describe the types of uses and disclosures that are permissible under federal and state law.

1. Treatment: I may use and disclose PHI in order to provide treatment to you. For example, I may disclose PHI to other health care providers involved in your treatment. I may share information in consultation with other licensed clinical supervisors or psychotherapists who are also required to protect disclosure in accordance with federal and state laws.

2. Payment: I may use or disclose PHI so that services you receive are appropriately billed to and payment can be collected or reimbursed from your health plan. For example, I may disclose PHI to permit your health plan to take certain actions before it approves or pays for treatment services.

3. Health Care Operations: I may use and disclose PHI in connection with health care operations including quality improvement activities, training programs, accreditation, certification, licensing or credentialing activities.

4. Required or Permitted by Law: I may use or disclose PHI when I am required or permitted to do so by law. For example, I may disclose PHI to appropriate authorities if I reasonably believe you are a possible victim or witness of abuse or neglect, domestic violence or other crimes. I may disclose PHI to the extent necessary to avert a serious threat to your health or safety or the health or safety of others. Other disclosures permitted or required by law include the following: disclosures for public health activities; health oversight activities including disclosures to state and federal agencies authorized to access PHI; disclosures to judicial and law enforcement officials in response to court order or other lawful process; disclosures for research when approved by an institutional review board; disclosures to military or national security agencies, coroners, medical examiners and correctional institutions or others authorized by law; disclosures regarding child welfare or elder abuse; disclosures to protect myself if a claim is made against me in court. All telephonic communication may be vulnerable to disclosure or breach of confidentiality by the very nature of its questionable security.

B. Uses and Disclosures Requiring Your Written Authorization
Psychotherapy Notes: Psychotherapy notes may be used or disclosed as per Section I.A. above. However, your written authorization or consent will be required for the notes themselves to be disclosed for other purposes which may include insurance matters and professional consultation.

II. YOUR INDIVIDUAL RIGHTS

A. Right to Inspect and Copy: You may request access to your medical records and billing records. All requests for access must be made in writing. Under some circumstances I have the right to deny access to your records or portions of your records. I may charge a fee to cover costs for copying and sending requested items. If you are a legal guardian or parent of a minor you must be aware that certain portions of the minor's record will not be accessible to you.

B. Right to Alternative Communications: You may request, and I will accommodate, any reasonable written request to receive PHI by alternative means of communication or at alternative locations.

C. Right to Request Restrictions: You have the right to request a restriction on PHI used for disclosure for treatment, payment or health care operations. You must request any such restriction in writing addressed to me. I am not required to agree to any such restriction you request.

D. Right to Accounting of Disclosures: Upon written request you may obtain an accounting of certain disclosures of PHI. This right applies to disclosures for purposes other than treatment, payment or health care operations, excludes disclosures made to you or disclosures otherwise authorized by you, and is subject to other restrictions and limitations.

E. Right to Request Amendment: You have the right to request that I amend your health information. Your request must be in writing, and it must explain why the information should be amended. I may deny your request under certain circumstances.

F. Right to Obtain Notice: You have the right to obtain a paper copy of this Notice.

G. Questions and Complaints: If you desire further information about your privacy rights or are concerned that I have violated your privacy rights you may contact me and/or file a complaint with the Director, Office for Civil Rights of the US Department of Health and Human Services. I will not retaliate against you if you file a complaint.

III. CHANGES TO THIS NOTICE
Changes to this Notice: I may change the terms of this Notice at any time. If I change this notice I will make the new Notice terms effective for all PHI that I maintain, including any information created or received prior to issuing the new Notice. If I change this Notice, I will notify you by email. You may always obtain any revised Notice by contacting me.
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