Services, Fees, Policies, & Forms

Daniel Weiner, MA LPC, LLC

Child, Adolescent, and Family Psychotherapy

SERVICES:

Individual and Family Psychotherapy: Individual and family treatment is provided for children, adolescents, and adults struggling with specific issues.

Assessment for ADHD/Neuropsychological Issues: In an effort to gain a better understanding of issues such as ADHD and executive functioning, an assessment can be provided for children and adolescents (ages 7 and up). An initial evaluation takes place with the child/family members to gather history and current symptoms. This is followed by a brief computer assessment regarding memory, simple and complex attention, general executive functioning skills/deficits, and visual-motor processing. Upon completion, a brief summary will be provided in writing to the family.

Group Psychotherapy: Group therapy is provided in several specific groups for children ranging in age from 8 to 24. For specific information about what groups are currently being facilitated, please contact me by phone or email.

Case Management Services: When providing care to children and adolescents, there are often times when communication with outside providers is helpful/necessary in coordinating care in order to make the treatment more effective. This particular communcation may involve academic planning, support with additional providers, etc.

Additional Services:

On-site consultation in homes and schools when requested and when appropriate
Attendance at PPT, 504 meetings, and other educational team meeting.

FEES AND PAYMENTS:
I am not paneled with any specific insurance companies. Upon request, I can provide you the necessary forms to submit for "out of network" reimbursement.Fees are required upon the time of your visit and I accept cash, check, and credit cards for your convenience. Please note, that while I will assist you with insurance matters, fees that are unpaid are ultimately the client’s responsibility. Please make sure you are informed of all policies regarding your insurance coverage. The following are my fees for individual, family, and group psychotherapy. I currently accept Visa, Mastercard, and Discover, and payment can also be made by cash or check. Other fees such as administrative costs are determined upon request. The following is a list of services and their specific fees:

Initial Psychotherapy Evaluation/Consultation (typically the first and second session): $250
ADHD/Executive Functioning Assessment: Cost determined based on scope of evaluations provided and fees range between $375 and $800
Individual/Family Therapy (60 minute session): $250
Individual/Family Therapy (45 minute session): $200
Individual/Family Therapy (25-30 minute session): $150
Group Therapy (45 minutes-1 hour): $55-70
Case Management (ie. Record review, communication with outside providers, etc.): $65 per 1/4 hour
On Site Consultation/Evaluation/Treatment: $350 per hr.(plus travel time)
In-Home Evaluation/Treatment: $350 per hour (plus travel time)

CANCELLATION POLICY: If you need to cancel an appointment, please contact me by phone or email with 24 hours advanced notice in order to avoid late cancellation or “missed appointment” charges. These fees are billed directly to you and cannot be submitted for insurance reimbursement.

ATTENDANCE POLICY: Recommendations regarding the frequency of visits is usually determined by the individual needs of each client/family. Therefore, these matters will be discussed at the end of your first appointment. If attendance to sessions is inconsistent and/or infrequent, this may impact the overall success of treatment. As a result, the continuation of treatment may be impacted if sessions are not maintained according to treatment recommendations.

PRIVACY POLICY: The privacy of your treatment information is extremely important. All records are maintained through a fully compliant electronic medical record system. Upon the initial meeting, you will receive my "Notice of Privacy Practices" which outlines how I keep your records confidential.

FORMS:

Authorization to Obtain/Release Information- This form allows me to communicate with other providers, family members, etc. and must be signed in order for any communication to occur with anyone other than the client/family. Please download, print, and forward this form when such coordination of care is requested: gallery/obtain releasewesthartford.

Credit Card Authorization: This form allows me to keep your credit card on file in order to process transactions. Receipts can be provided monthly, or upon request. If you would like to keep a card on file, please download, print, and forward this to me via fax or email. gallery/creditcardform.doc.