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Positive   Break                                  205-621-9525
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    Privacy Policy    

                  CONSENT OF OUR PRIVACY POLICY:

  Please read these policy carefully this information will apply throughout Session. I will answers any question you have at your first appointment.

 Confidentiality: Your privacy is extremely important .All protected health information (PHI) will be kept confidential.
You will be able to print a copy of the privacy practices. In almost all cases your consent will be obtained prior to the release of any (PHI)Medical record and/ or (PHI) may be released regardless of consent in the following circumstances.

​ I. According to the states and local laws, all cases of physical or Sexual abuse , Neglect of Minors and the Elderly must be reported to the appropriate Authority.

 2. All cases in which there exists a danger to your self and others must be reported to the Authority.

 3. When authorized by the recipient of services, in order to process medical insurance claims and authorized payment of benefits.

 4. If you are in need of emergency service and other medical personnel needs please contacted (911) FOR HELP.

 5. If you become involved in specific kinds of legal proceedings, the courts may subpoena information concerning your Session.

 Session with Minors: Children under the age of 18 years will be provided only with the consent of the parent or legal guardian. In cases of divorce, a copy of the custody agreement must be provided.Most custody decrees entitle the non- custodial parent. When you signing this consent form the client acknowledges that she or he is the guardian of any minor in treatment session. You must provided a. Copy of the custody agreement if you are not  the parent as well.
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  Billing and Payment information: If there is a change in your insurance coverage, your address, other demographic information between appointments, or- client's / guardian's responsibility to supply information before the next appointments.

 Session Duration and Fees: Initial Diagnostic Interview (1 hour) 50-60 Minute Strategy Session

 50-60 Minute Family Strategy session. Court Appearance fees:$200.00 per hour that doe's include if traveling to a other state that fees is setrpiv. .Some exceptions may apply based on insurance coverage.

 All coaching payments are taken through PayPal at a flat rate of $80.00 per session. Promptly enter your credit or debit card to proceed with this appointment. it's fast, free and secure.

 With the exception if you are covered by your insurance them our office will bill your insurance company for hour services.

 Cancellation Policy:All fees are due at the schedule your appointment. if you do not cancel your appointment with 24 hours your fees are not refundable also if you are covered by insurance and you miss your appointments  and didn't cancel with in the 24 hours them you are sole responsibility.This fees will be $27.00.

 Forms, Letter, and other Documentation: Any additional paperwork, letter, and forms not specifically related to office care will be subject to a fee based on the complexity and time completed prior to the release of the paperwork.

 SPEAKER -POLICY: What other potential expenses you should be aware of? Traveling, meals, Hotel accommodation and other incidentals. If the speaker does not appear or perform to the terms of this .Agreement, due to conditions that are beyond the control of the Speaker, for example medical disability and or an act of God that is outside of the speaker control. Them the payment will be return in full.

 If there is a act of God with the business  for example a . Earthquake ,Storm fluid the building were the presentation will be  held then you will have your payment return in full.

 CANCELLATION: Postponing a booking then cancelled, if it not one of the above it will be treated as a booking you need to notify us in (7) business days. If not your deposit will not be return.

 POLICY: All payment should be paid in advance before the day of presentation.





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 Today: 205-621-9524




                                  


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