Policies

Please review all our policies to be sure you understand the binding nature of the therapeutic relationship and what you can expect from us, and what we expect from you. Under each category, please provide BOTH YOUR & YOUR PARTNER'S INITIALS, to indicate that you have read through, understand and are in agreement with JHFS, LLC policy.

SERVICES*
Includes treatment for individuals, couples and families regarding mental illness, adjustment problems, substance abuse/dependency.
CONFIDENTIALITY*
You have the right to confidentiality. No personal information will be released without your written consent, unless: a) abuse or harmful neglect of children, the elderly or disabled or incompetent individuals is known or reasonably suspected the validity of a will of a former client is contested b) information related to counseling is necessary to defend against a malpractice action brought by a client c) an immediate threat of physical violence against a readily identifiable victim is disclosed to the counselor, d) in the context of civil commitment proceedings, e) where an immediate threat of self-inflicted harm is disclosed to the counselor f) the client alleges mental or emotional damages in civil litigation or his/her mental or emotional state becomes an issue in any court proceeding concerning child custody or visitation g) the patient or client is examined pursuant to a court order h) in the context of investigations and hearings brought by the client and conducted by the board, where violations of this act are at issue i) in dispute with credit charges filed by client, JHFS, LLC may release signed consent for charging and client signed policies to identify agreement to charges
CONDUCT*
CONDUCT: Sexual intimacy with a client is never appropriate. Counseling relationships are professional in nature.
FEE FOR SERVICE*
Fees are to be paid at the time the service is rendered. Payment may be check, cash or credit. There is a 3.5% charge for credit. All returned checks will incur all associated fees.
CANCELLATION POLICY*
If for any reason you need to cancel an appointment, 24 hour notice is required, or the full fee will be charged. I give permission for JHFS, LLC to charge my credit card for this charge.
RELEASE OF INFORMATION*
I understand that in the event of a credit card charge dispute, I authorize JH Family Solutions,LLC, located at 480 South Cache St., PO Box 1600, Jackson, WY 83001 to disclose to the Square company any necessary information to resolve the dispute.
TERMINATION POLICY*
If, for any reason, there are more than 3 consistent no show/cancellations, or inability to schedule appointments consistently as necessary to progress with therapy, JHFS, LLC reserves the right to terminate treatment due to fragmentation.
Name*
First Last
Typing my name above constitutes my signature and agreement to terms of this document
Date*
MM slash DD slash YYYY
Partner Name*
First Last
Typing my name above constitutes my signature and agreement to terms of this document
Date*
MM slash DD slash YYYY
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