Thomas A Peltz

FAQ: Therapeutic Treatment Agreement

- My therapist is a mandated reporter of neglect, harm or abuse to minors, elderly, and to all persons considered handicapped. Also, the therapist will report cases of threat or harm to self or others. My therapist may at times request outside clinical supervision, and will maintain all standards of confidentiality. Written "Releases of Information" will be requested when needed. Thus, confidentiality will be protected by my therapist, except in the above listed case(s), or as required by legal and professional standards of care.

Thomas A Peltz

- Appointments will be attended on time. At least twenty four hours notice is required for the rescheduling of appointments, or patient may be responsible for a "No Show" full rate payment.

- Full payment is due in the form of a check at the time of treatment, unless other arrangements have been made in advance. Patient will be fully responsible for any extra expenses which might occur outside of 'normal clinical duties' such as: legal expenses, paperwork, and/or telephone contacts.

Thomas A Peltz

- No therapy will be offered if prior alcohol or illicit drug use occurred on the day of the scheduled treatment session.

- Violence will not be tolerated. Violence may result in termination of therapy with my therapist -- and/or legal charges, and expenses.

- Attempts will be made by the therapist to return patient communications in a timely manor. Mechanical errors can occur however with communication devices. Should clinical emergencies arise; the patient will immediately report to the local hospital emergency room, and ask that physician to notify the therapist regarding the outcome.