Explanation of Forms and Policies
Fees and Payment Information:
My standard session fee is $160 for a 55 to 60 minute session. Additional length sessions are prorated based upon $160 per hour. I accept checks, cash and credit cards for payment. Please be prepared to pay for sessions at the time of service unless you have made other arrangements in advance. If you choose not to leave a credit card on file, it is often easiest to process payment at the beginning of session so we can focus on your session fully for the remainder of the appointment time.
It is my policy to charge for appointments booked unless they are cancelled at least 48 hours or 2 business days in advance. (i.e. an appointment at 2:30 pm on Wednesday must be cancelled at or before 2:30 pm on Monday to avoid being billed, an appointment at 10 am on Monday must be cancelled by 10 am on Thursday, etc.) When an appointment is booked that time is not available to other clients, for meetings or any other activities. Please let me know in advance if you cannot keep your appointment.
By law and professional ethics, your sessions are strictly confidential. Generally, no information will be shared with anyone without your written permission. There are, however, a number of exceptions to this confidentiality policy.
- If you report that you or another person has been the victim of child abuse, I am required by law to report this to the authorities investigating child abuse.
- If you report that you or another person has been the victim of elder or dependent adult abuse, I am required by law to report this to Adult Protective Services or other appropriate authorities.
- If you threaten to seriously harm yourself or someone else, I may be required to take one or more or the following steps: contact police, warn the potential victim, or take other reasonable steps to prevent the threatened harm.
- If you sign a release of information requesting and authorizing me to discuss or verify your participation or other treatment information.
- If I am ordered by the court to testify or release records. In this situation, I may be required to give a summary of the case records whether or not a release of confidentiality was signed.
- The other possible exception to complete confidentiality would become relevant if I should need to seek consultation from colleagues regarding your case. If this should be necessary, I will not use your name or any combination of identifying data that would make it likely that your identity would be ascertained by others.
Notice of IRC Subchapter S Corporate Ownership: Please be aware that Alice Petty-Hannum, MFT is a business held and owned by an IRC Subchapter S Corporation; Bridges to Self-Empowerment, A Marriage and Family Therapy Corporation. Alice Petty-Hannum, MFT is managed solely by Alice Petty-Hannum. This IRC Subchapter S Corporation is family owned and there are no other partnerships or affiliations with others who occupy office suites at 406 Chinn Street, Santa Rosa or any other location.