If the session is interrupted due to an emergency, address that issue first, and call me back after you have obtained emergency services.

    If the session is interrupted and you are not having an emergency, disconnect from the session and I will wait two (2) minutes and then re-contact you via the telepsychology platform on which we agreed to conduct therapy. If there is a technological failure and we are unable to resume the connection, we may need to use another platform or reschedule the session.

    Champion Psychological Service, LLC - FEES


    Fees If No Insurance Coverage for Teletherapy with CPS, LLC

    You may choose to contract for telepsychology services as a private payor if your insurance does not cover such treatment. You will agree to be billed. The rate for the initial session is $180 for an initial session and $150 for follow-up 45-minute sessions. I can provide a sliding scale to clients who qualify.

    Copayments

    All copayments and fees for treatment are expected at the beginning of each session.

    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 may be $ 50 billed for each missed appointments unless I am given 48-hour notice.

    If you have a credit/debit card on file via Square, your credit/debit card will be charged the $50 missed appointment fee automatically.

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

    Records

    CPS, LLC will maintain a record of the telepsychology session in the same way records are currently maintained for in-person sessions.

    Informed Consent

    This agreement is intended as a supplement to the Client Information and Informed Consent signed and agreed to at the onset of our clinical work together and does not amend any of the terms of that agreement.

    Your signature below indicates agreement with the terms and conditions of this document.



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