Parental reunification therapy is a specific type of family therapy and differs from traditional therapy in several ways:

1. 1. Sessions are not confidential. Unlike traditional therapy, the clinician is often expected to report back to third parties (e.g. attorneys, the Court). Disclosures may include information relating to treatment progress, treatment compliance, and the like.

2. 2. Insurance may or may not cover the cost of therapy sessions. Insurance carriers cover that which they deem to be of “medical necessity.” Court-related treatment, such as reunification therapy, may not meet this criterion. The client remains responsible for the payment of any fees associated with therapy or other treatment.

3. 3. Unlike traditional psychotherapy, which might have a more general focus, reunification therapy has a very specific goal: reunification.

Set forth below are the general terms of this office’s involvement in this case.

The majority of work is billed at an hourly rate. Work in this case will be billed at a rate of $150 per hour. This rate will apply to all individual or family sessions conducted as part of reunification therapy which are not covered by insurance. In addition, this rate will apply to any and all time spent reviewing relevant records, answering calls, text messages and emails related to your case, report writing, and if necessary testifying in court.

In addition, you will be charged the full fee for any scheduled office visits, whether or not you attend those visits.

It is customary to secure a retainer fee from all new clients. The sum of $900.00 is due in full at the time of the initial therapy session. This retainer will be applied to the cost of services and will be itemized on your initial billing statement. If there is an overpayment of retainer, the difference will be sent to you within fifteen (15) days after the case is closed or our services are terminated.

Periodically, this office will send you statements that indicate the current status of your account, both for services rendered and for costs incurred on your behalf. These statements will include a detailed description of the services performed, the hours worked, the costs (if any), and the total amount of the statement or invoice. You agree that it is your responsibility for paying each invoice promptly upon receipt.

This office will endeavor to complete work promptly and efficiently in accordance with the highest professional and ethical standards. However, you have the right to terminate services at any time upon written notice to this office. Assurance Behavioral HealthCare has the right to terminate services to you, upon written notice, if we determine that continuing services would be unethical or improper, if you fail to cooperate with a reasonable requestor you fail to pay for services in a timely manner.

If you have any questions regarding any of the above terms, please contact this office. If the agreement is in order please return the following: (1) the agreement as executed by the appropriate person in the place indicated below and (2) a check in the amount of $600 made payable to Assurance Behavioral HealthCare at the time of your first session. I look forward to working with you.

The foregoing accurately sets forth the terms of our engagement, and is approved and accepted.