Informed Consent
In signing this consent form, I agree to the following:
I am engaging in consultation or therapy sessions with Dr. Kacie LaChapelle.
Disclosure of any history of psychiatric conditions, illnesses, hospitalizations for psychiatric reasons, ongoing psychiatric treatment, or medication use.
Awareness that some issues and topics we may discuss can be challenging and may stimulate emotions that can affect me beyond the session. I acknowledge my responsibility to handle any such emotions, and to reach out for appropriate help, including calling 911, in the event of an emergency.
The nature of this professional relationship is on a fee-for-service basis, which limits us primarily to scheduled sessions and brief calls, texts or e-mails for scheduling purposes or updates.
Confidentiality
Client confidentiality is of the utmost importance. Verbal communication and clinical records are strictly confidential with the exception of the following circumstances:
If you or your child reports physical of sexual abuse of a minor or an elder person, I am obligated by law to report to relevant authorities charged with protection of these entities.
In the event that that you provide information that your intention is to harm yourself or others.
As exempted by your signed release of information identifying specific recipients with whom you are giving me permission to communicate on your behalf.
Fee Structure
Sessions are provided either on a fee-for-service basis or through certain insurance plans. The direct payment fees are $150 per hour and $225 for 1.5 hours. When not using insurance, payment is requested prior to each session. In the event that insurance does not fully or partially reimburse for services rendered, and balance due will be the responsibility of the client.
You may pay using the following methods:
Venmo: @Kacie-Lachapelle (7774)
Credit card (processing is available on my website: gracehappenstherapy.com)
Cash or check. Please schedule directly through me prior to booking appointments.
Cancellation Policy
In the event that you need to reschedule an appointment, please provide as much notice as possible - via text or email. Missed appointments and appointments cancelled with less than a 24 hour notice are forfeited and the session fee is due in full.