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FEES$200 - 50 minute individual session $250 - 90 minute family session Sliding Scale Available - please inquire Superbills
A superbill is a detailed receipt you can submit to your insurance provider to seek reimbursement. HMOs generally do not offer reimbursement. You pay your therapist directly and, depending on your insurance policy, you are reimbursed by your insurance later. |
INFORMED CONSENT + OFFICE POLICIES
Informed Consent
As your therapist, it is my job to ensure you are able to give your informed consent to our work together. Prior to the beginning our work, I will provide detailed documents for you to review and sign regarding the following areas of informed consent:
Where we meet:
All virtual sessions held via SimplePractice
In-person sessions: 5565 Carpinteria Avenue Suite #23, Carpinteria, CA 93013
Payment, Cancellations, Rescheduling:
Communication:
24/7 Crisis Support:
Good Faith Estimate Under the No Surprises Act
You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services. You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.
Notice to Clients The Board of Behavioral Sciences receives and responds to complaints regarding services provided within the scope of practice of (marriage and family therapists, licensed educational psychologists, clinical social workers, or professional clinical counselors). You may contact the board online at www.bbs.ca.gov, or by calling (916) 574-7830.
As your therapist, it is my job to ensure you are able to give your informed consent to our work together. Prior to the beginning our work, I will provide detailed documents for you to review and sign regarding the following areas of informed consent:
- Informed Consent for Adults and Youth
- Telehealth Informed Consent
- Walking & Nature Session Informed Consent
- Limits to Confidentiality
- Privacy Practices
Where we meet:
All virtual sessions held via SimplePractice
In-person sessions: 5565 Carpinteria Avenue Suite #23, Carpinteria, CA 93013
- My office is at 5565 Carpinteria Ave, Suite #23, Carpinteria, CA 93013. There is parking next to the building. My suite is on the second floor. Go through the gate and up the stairs. The stairs are inside the courtyard. My suite is upstairs and to the left. There is a waiting room once you enter the suite. I will meet you there at our session start time.
Payment, Cancellations, Rescheduling:
- I accept cash and cards. Payment is expected at the time of services. If you pay by card, your card will be on file with Simple Practice and is charged on the day of your appointment via SimplePractice.
- It is important for the continuity of therapy that you come to all sessions. Since your appointment time is reserved exclusively for you, I have a 48-hour cancellation policy. In other words, if you cancel within 48-hours of the appointment time you will be charged for the session.
- Email or text me to cancel or reschedule your appointment. I will do my best to accommodate late requests (within 48-hours) to reschedule in the same calendar week but I cannot guarantee availability.
- Please email or text me if you will be late. I will wait 15 minutes past the start of your session if I do not hear from you at which time you will be considered a "no-show" and charged your full fee.
- Fees are subject to annual change to accommodate inflation and increased experience and expertise. You will be provided notice prior to any fee adjustments.
Communication:
- I do my best to respond to clients within 24 hours during the work week.
- I check my email and phone Monday through Friday. Contacts received Friday afternoon may not be responded to until Monday.
- If you are a member of a therapy group such as family therapy, please do not share anything with me you would not want the entire group to know.
- Please note I am not available 24/7 for crisis support.
24/7 Crisis Support:
- Santa Barbara County Crisis Line 888-868-1649
- Ventura County Crisis Line 866-998-2243
- Trevor Project Crisis Support for LGBTQ: https://www.thetrevorproject.org/get-help/
- National Suicide Prevention Hotline 1-800-273-8255
Good Faith Estimate Under the No Surprises Act
You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services. You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.
Notice to Clients The Board of Behavioral Sciences receives and responds to complaints regarding services provided within the scope of practice of (marriage and family therapists, licensed educational psychologists, clinical social workers, or professional clinical counselors). You may contact the board online at www.bbs.ca.gov, or by calling (916) 574-7830.
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Kara Petersen, LMFT (she/her)
Licensed Marriage and Family Therapist #145462 5565 Carpinteria Avenue, Carpinteria, CA 93013 [email protected] (805) 707-2074 "Speaking and listening are a form of psychic breathing." -Carol Gilligan |
