Policies & Forms

Our Service Agreement & HIPAA Privacy Notice

Please read the full versions of our Service Agreement and HIPAA Privacy Notice, but please do not print these documents unless you want a copy for your records. The Service Agreement explains all of our policies while the HIPAA privacy notice explains our privacy policies. By signing the Consent for Treatment form and the HIPAA Privacy Notice you are agreeing to adhere to Centers for Family Change policies. Therefore, we strongly encourage you to read these documents.

Our Financial Policies

Please read our Explanation of Financial Policies which offer a more detailed explanation of our Financial Policy form (which you will need to read and sign). By signing our Financial Policy, you are agreeing to honor our financial policies, including paying for sessions you cancel with less than a full 24 hours’ notice.

If you are not using your insurance you will receive a Good Faith Estimate. Under Section 2799B-6 of the Public Health Service Act, also known as the No Surprises Act, all health care providers (including psychologists, social workers, and counselors) are required to provide a Good Faith Estimate of the cost of services to all individuals who do not have health insurance, are uninsured, or who are not using their health insurance.

Our Teletherapy & Communication Policies

You can read the full versions of our Teletherapy policy and Communication policy but please do not print these documents unless you want a copy for your records. Please review these to better understand our teletherapy services and our efforts to improve communication with you.

Our Policy for the Treatment of Children and Adolescents

You can read the full version of our Policy on the Treatment of Children and Adolescents but please do not print this document unless you want a copy for your records. Please review this document to be sure you understand our policies regarding the treatment of children and adolescents.

Our Policy Explaining Why we do not Complete Forms or Write Letters

You can read the full version of our Policy Explaining why we do not Complete Forms or Write Letters. This policy explains our rationale for not completing forms or writing letters for our clients.  Please do not print this document unless you want a copy for your records. Please review this document to be sure you understand why we decline to complete forms.

Our Policy Regarding FOID Cards

You can read the full version of our Policy Regarding FOID Cards. Mental health professions are mandated reporters for any client or therapy participant assessed as presenting a clear and present danger to themselves or others.