LITIGATION POLICY AND FEES FOR COURT-RELATED SERVICES
It is my policy to avoid involvement in your litigation to prevent having to disclose your confidential information in court. I do not want to risk the negative feelings that can result from court or deposition testimony. The litigation involvement would negatively affect our therapeutic relationship and/or progress on your individual therapeutic goals. The nature of the therapeutic process often involves making a full disclosure with regard to private and personal matters. If you become involved in any legal proceeding during your therapy with me, including but not limited to divorce and custody disputes, or personal injury lawsuits, you agree that neither you, your attorneys, nor anyone acting on your behalf will subpoena records from my office, nor subpoena me to testify in court, in a deposition or in any legal proceeding.
If you plan to get involved in a court case, I recommend that we discuss it before renouncing your right to confidentiality and incurring additional costs as detailed in this document. If you involve me in your litigation, or if your attorneys subpoena me to provide my records, testify in court, or give a deposition in violation of this agreement, I will comply with lawfully issued subpoenas. If I am subpoenaed to provide records or testimony, I reserve the right to terminate our professional, therapeutic relationship immediately and refer you to other mental health providers.
Compensation: You further agree that should I, nevertheless be required to testify in any proceeding concerning you or your care, you agree to provide compensation at a rate of $300 per hour. Compensation includes but is not limited to preparation, record review, transportation charges (door-to-door), waiting time, and time spent testifying in court or deposition regardless of which party issues the subpoena. A minimum payment of $______ must be settled prior to any hearing. Also, there will be a minimum hour requirement of 4 hours ($1200). You also agree by your signature below to execute and sign a Credit Card Authorization and provide a valid credit card to ensure payment for the time I must spend involved with your litigation. I will accept cash, money orders, cashier’s checks, or credit cards for payment. All payments are due 48 hours prior to the scheduled court appearance or disposition. Payments are due no later than noon on Thursday if the court hearing/deposition is scheduled for a Monday. Your signature below will authorize me to run these charges to the credit card on file unless you notify me at least 48 hours in advance with the intention of making the payment with cash, money order, or cashier’s check. THESE SERVICES ARE NOT COVERED BY INSURANCE.
Cancellation: There is a 48-hour cancellation policy for court and depositions since I must clear my schedule and cannot meet with clients during that time. Any cancellations that occur within the 48-hour time frame of the court appearance or deposition are NON-REFUNDABLE.
Services that are NOT within the scope of my practice and I will NOT perform/provide include, but are not limited to: Social studies or custody evaluations; recommendations regarding possession, custody, access to or visitation with a minor; medication or medical advice; and legal advice.
PROFESSIONAL RECORDS/CLIENT RECORDS
I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. I understand that health information about you is personal. I am committed to keeping health information about you secure. You are entitled to a copy of your records upon request, except in unique circumstances that pose a danger to you. Should you, or a representative acting on your behalf, request a copy of your medical records, a reasonable fee will be charged in accordance with the existing Michigan law at the time of the request. At this time, paper copies of medical records can cost up to $1 per page for the first 20 pages, 50 cents per page for pages 21 through 50, and 20 cents per page for pages 51 and/or more. I may determine and suggest that it will be beneficial for you to collaboratively review the records, either with me or another healthcare professional of your choice, to ensure a comprehensive understanding of the information contained therein. Please visit the Michigan Legislature link below for additional information on the Medical Records Access Act.