Financial agreement
Soundings translation page
Soundings at The Women’s Center of Southeastern Michigan
Financial agreement
C. When do I pay?
All fees are payable in full at the time of service. You may pay in cash, by check, or by credit card -- in-person or on-line. If you owe for more than one session, your therapist will be unable to continue to see you until your outstanding balance is paid in full or you have reached a payment agreement.
D. How do I pay?
You may pay in cash, by check, or by credit card — in person or online.
Responsibilities
A. Appointments
You are responsible for coming to your session at the time we have scheduled. Sessions last 45-55 minutes. If you are late, your visit will end on time to honor the next person’s session. If you need to cancel an appointment, please notify your therapist at least 24 hours before the session by sending a message or email.
We understand that bad weather, illness, traffic, or other unexpected events may lead you to have to miss a session. Please give us advanced notice whenever possible. If you do not show up as planned, it means that the hour the therapist set aside for you could not be used by someone else.
The Women's Center is closed on all national holidays and on Ann Arbor School District “snow days” (unless you and your therapist agree to make an exception). When appointments must be changed or canceled, your therapist will make every effort to let you know. We ask you to do the same.
B. Contacting your therapist
Under the provisions of the Health Care Information Act of 1992, a therapist may legally speak to another health care provider or a member of your family about you without your consent, but we will not do this unless the situation is an emergency. You may give written consent for your therapist to share information with whomever you choose, and you may revoke that permission in writing at any time. You may request anyone you wish to attend therapy with you, but we ask you to work with us to clarify expectations ahead of time.
C. Emergencies
You are responsible for prioritizing your own mental and physical safety. Your therapist will do everything reasonable to help you during times of crisis, however we do not offer psychological coverage 24 hours a day, seven days a week. Soundings therapists do not have the capacity to respond rapidly to emergencies. If you feel that you are in danger of harming yourself or others, call 911 or immediately get to the closest emergency department. If, over time, it becomes clear that you need more intensive care than can be provided in this setting, your therapist will refer you to a practitioner who can provide expanded coverage
D. Authorization for services
I am voluntarily authorizing individual psychotherapy services for myself or my child at Soundings. I understand that I may be charged for a missed appointment if I do not provide adequate notice. I agree to pay the fee owed at each session.
G. Consent to Treatment
Client name: ________________________________________________________________________
Client signature: _____________________________________________________________________
Are you the parent/guardian of this client?
Yes ______
No ________
Parent/legal guardian name (if applicable): _____________________________________________________
Parent/legal guardian signature (if applicable): __________________________________________________
Date: ____________________________________________________________________________
A. How much will this cost?
Soundings fees are based on your ability to pay. We believe that everyone deserves emotional and mental health support. We encourage you to speak with your therapist and come up with a fee that you can manage on an ongoing basis. Fees generally range from $10 to $40 per session according to income.
Good-faith estimate. Anyone who does not use health insurance (i.e., self-pays) has a right to receive a good-faith estimate of what services will cost. Until you and your therapist discuss what you are hoping for in therapy, we can’t really predict how long therapy will take. The number of sessions in a year could be as high as 50 or as low as 1-2.
Actual cost of services. Community members who believe in equal access to health care contribute to us so that we can continue to offer counseling and other services at substantially reduced rates. Our standard psychotherapy fee is $175 per session (longer first session = $225).
Fees for service go to The Women’s Center, not to individual therapists. Whatever you can afford to pay makes it possible to provide ongoing services for you and others in similar situations.
In the future, you may be in a position to "pay it forward" and make a counseling opportunity available to someone else.
B. What happens if I lose my job in the middle of therapy?
One of the benefits of participating in therapy at a women’s nonprofit is that we understand that things happen over which we have little to no control. If you lose (or gain!) a job or health care coverage during the course of therapy, you have the option of renegotiating your fee based on the new circumstances.