Counseling Services
Policies, Fees, Informed Consent

Beverly Cooper LMHC

Policies, Fees, Informed Consent
and New Client Registration Form

Please complete section A and B --then submit the form below.

At this time Beverly's practice is limited to
Couples and Family, Women's Issues, Children and Teens
Face-to-Face
Section A. Policies, Fees and Informed Consent
 
Counselor’s Qualifications: Beverly Cooper LMHC
Licensed Mental Health Counselor (LMHC) by the Florida Dept. of Health. Master of Science Degree in Human Services/ Counseling from Springfield University. In private practice for eight years.

 

Standard Counseling Fees: 
  • 50 Minute Face-to-Face Counseling  $90 self pay  (Normally $120). 

  • Some Insurance/EAP accepted with authorization

  • Additional time is prorated.

  • Late Cancellations and No Shows. $25 service fee.

  • Documentation Letters and Forms (i.e. FMLA, Employer, School, Court) $25-$120.

 

Insurance: Insurance is a contract between you and your health insurance company. Your policy may cover a percentage through reimbursement or contracted provider payment. Insurance does not cover late cancellations or no-shows --you will be billed directly for these. Please note: If you seek to file insurance you are authorizing the counselor to release an insurance required medical diagnosis and session notes which may result in a degree of loss of confidentiality. Please know the benefits/requirements of your Insurance/EAP before submitting form and making an appointment.

 

 
Payment: Payment due at time of service. Currently accepting cash only

 

Cancellations and No-shows: We have a 24 Hour cancellation/reschedule policy. If you miss your appointment, reschedule, or cancel your appointment with less than 24 hours notice you will be billed $25 for the appointment missed. Insurance/EAP does not cover this expense.  By scheduling an appointment you agree to this policy. 

 

Confidentiality: All communication between you and your counselor is confidential.  Exceptions to this rule arise when there is immediate danger of physical harm to you or others.  The law also requires an immediate report of known or suspected cases of child or elder abuse.

 

Identification: Clients are required to provide a photo id. 

 

WE ARE NOT A CRISIS HOTLINE. If you have an emergency call 911.

Section B: Please Complete and Submit The Registration Form Below

Your appointment is not complete until the registration form is received.

 

Christian LifeSkills

For Personal & Spiritual Growth

Larry Roach - Professional Licensed Counselor and Teacher

TM

c. Larry Roach 2000