Policies, Fees, Informed Consent
Larry Roach LMHC
Policies, Fees, Informed Consent
and New Client Registration Form
Please complete section A and B --then submit the form below.
At this time my practice is limited to
INDIVIDUAL ADULT COUNSELING
Face-to-Face or by Phone
Section A. Policies, Fees and Informed Consent
Counselor’s Qualifications: Larry Roach, LMHC
Licensed Mental Health Counselor (LMHC) by the Florida Dept. of Health. Master’s Degree in Professional Counseling. Bachelor’s Degree in Psychology. Additional graduate level training in Pastoral Counseling and Theology. Ordained Minister. Certified Critical Incident Stress Management Provider (CISM). Employee Assistance Guidance Expert.
Standard Counseling Fees:
50 Minute Face-to-Face Counseling $90 self pay (Normally $120).
50 Minute Phone Counseling $75 self pay (Normally $120)
Some Insurance/EAP accepted with authorization
Additional time is prorated.
Late Cancellations and No Shows. $25 service fee.
Documentation Letters $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. Upon request, we will provide a formal receipt for you to submit to your insurance company. We also honor most EAP services through your employer with authorization, (Ins/EAP, 50 minute individual session only). We are not in network for Gov't Ins., BCBS, Aetna Beh., Humana or Tricare. 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. On the form below please make sure to include your insurance ID#, Group#, Authorization#, Deductible, and Co-payment.
Disability Claims: Normally, we do not provide documentation or evaluations for short or long term disability claims. For this service, it is recommended that you seek an evaluation with a physician, psychologist or psychiatrist.
Payment: For Phone Counseling, Following your appointment you will receive an invoice by email for the amount due which you may pay with a credit card, debit card or a Health Savings Account (HSA). Face to Face appointments are due at time of service.
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 (ie. driver license) via email or text before time of service. Send photo via text to 407-716-7083
Please Note: Phone counseling is not suited for people who are suicidal; who have severe mental health issues; or for couple's or family counseling.
WE ARE NOT A CRISIS HOTLINE. If you have an emergency call 911.
Section B: New Client Registration Form