CHAMPION PSYCHOLOGICAL SERVICES, LLC

P.O. Box 2623 Mercerville, NJ 08619

Carmen Lynn Hodges, Psy.D., LCADC

New Jersey Licensed Psychologist #35S10049600

New Jersey Licensed Clinical Alcohol & Drug Counselor #37LC0006900

drhodges@championpsychsvcs.com

Phone:609-638-7560

Fax:609-581-4762

WELCOME TO CHAMPION PSYCHOLOGICAL SERVICES, LLC. Psychotherapy can have benefits and risks. Since therapy often involves discussing difficult aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. At the same time, psychotherapy has been shown to improve relationships, to provide solutions to specific problems, and to provide solutions to specific problems, and to reduce feelings of distress. Psychotherapy involves a large commitment of time, money, and energy, so you should be careful about the psychologist you select.

Also, please note as your psychologist I am not permitted to perform for you certain evaluations (e.g., disability or forensic exams) or to write letters regarding emotional support animals. Such practices need to be provided by a neutral 3rd party professional.

Please note office policies:

Appointments and Cancellations

Appointment times are set to accommodate client schedules as often as possible. To properly assist you, I ask that you keep your appointment on a regular basis. I will be glad to discuss any need for a change in scheduling. If you cannot keep your scheduled appointment, please call 609-638-7560.

By law, I am not permitted to bill insurance for missed appointments. Therefore, you will be billed for any missed appointments unless I am given 48-hour notice.

If you need to cancel an appointment, please call, and leave a message. Please do not text, or send messages via messenger. These modalities are not HIPAA compliant.

If you are 15 minutes late for your appointment without prior notification, you will be billed for a NO SHOW Appointment.

Payment/Billing

In any professional relationship, payment for services is an important issue. This is a crucial issue in therapy, where clarity of relationships and responsibilities is a goal of treatment. Payment or co-pay is expected at the time of your visit. All Electronic Payments are processed via Square.com via our secure payment system on our the website (www.championpsychsvcs.com)

Please note that you are responsible for your deductible amount as specified by your insurance company. Please advise of any insurance changes immediately.

The following are accepted methods of payment for Telepsychology appointments: Visa, Mastercard, American Express. Any bank fees will be your responsibility.

The following are accepted methods of payment for In-person appointments: Visa, Mastercard, American Express, Money Order, and Checks. Any bank fees will be your responsibility. All bills not paid within 60 days are subject to collections.

If you are having financial difficulties that prevent timely payment, please advise.

Services not covered by your insurance company may be billed separately such as: Completion of forms, and extensive consultations (more than 15 minutes) with other providers.

Confidentiality

If you use your health insurance to pay a part of your fees, I must give the insurance company some information. They usually want your diagnosis, the fee, when therapy first began, and a treatment plan or summary of treatment. It is against the law for insurers to release any information about our office visits without your written consent.

I hope this information will prevent any misunderstanding later. In this way, treatment can proceed efficiently.

If you are having a psychological emergency, you may call me at (609) 638-7560 if you need to speak with me. Leave a message if I am unable to pick up the phone when you call, I will get back to you as soon as possible. If there is an emergency, please contact /go the nearest hospital immediately. Please note, I am not available 24 hours per day, or 7 days per week.

I have provided some additional resources you may also find helpful on my website. Please print and use them as a resource

Please note, for your convenience my practice email address drhodges@championpsychsvcs.com is a HIPAA secure website. You may email your intake paperwork, insurance documents, etc. to this website.

However, this site is to be uses for the exchange of information and not for therapy sessions.

You may also fax pertinent information to my private office at the following number: 609-581-4762.

Please sign below to verify that you have read this orientation and agree to the terms indicated in these policies.

I am looking forward to working with you,

Carmen Lynn Hodges, PsyD, LCADC


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