CHOICES IN LIVING COUNSELING CENTERS, INC.
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ENROLL IN A RELAPSE PREVENTION PROGRAM
I(a). PROGRAM:
1(b). CHOOSE A LOCATION
RELAPSE PREVENTION PROGRAM
I(c). CHOOSE A CLASS DAY & TIME :
II. FEES:
We appreciate clients paying at time of service. Clients may be refused service without payment
at time of service or a signed financial agreement. We understand
that you have other financial obligations, such as Court costs, fines, restitution, and Probation
Fees, etc., as well as your ongoing regular monthly obligations and
are not unsympathetic regarding your obligations. Without adhering to payment policies,
everyone is affected and mental health services for everyone can become
limited. A client who experiences financial difficulty may be placed on "FINANCIAL HOLD"
status. Financial agreements are made with the office and cannot be made
with a counselor. To attend final session(s), balances have to be paid in full, and in order to be
successfully discharged, balances have to be paid in full. If a client has
an ongoing outstanding balance, accounts and account-holder information, including contact
information, may be provided to an in-house or contract collection service.
Your right to privacy and confidentiality in such cases is automatically waved and collection
costs including attorney's fees may apply. Because clients occupy limited
enrollment slots, they pay the regular group or service cost for all absences. Any missed sessions
must be made up and fees paid a second time. All unexcused
absences are required to be reported to Probation Departments as noncompliance and such clients
are subject to discharge. If discharged, Program and service readmittance costs apply. If discharged, prior attendance and/or portions of prior attendance may no
longer count. Excused absences are (1) jail, preplanned vacation(s),
and illness. Preplanned vacations may be taken 2 times per year with 30 days notification and
with Probation approval. Excused illnesses must be accompanied by
a licensed physician's statement. We appreciate your cooperation.
III. UNDER THE INFLUENCE:
Clients will be given an unexcused absence, charged for class, and reported to Probation if they
come to class or to any Choices location under the influence of
alcohol and/or drugs. They may also be required to undergo Monitoring Services such as
Antabuse, Naltrexone, regular Random Urinalysis Screens, and/or regular
breathalyzer screens to help them maintain sobriety while enrolled in a Choices Program. If
monitoring services are applied, a client is responsible for all costs involved.
IV. MONITORED SOBRIETY:
If you are required to take Antabuse (disulfiram), there must first be a brief medical examination
by a physician who may/may not approve a prescription for Antabuse.
A client may purchase Antabuse or other required medication at any pharmacy with prescription
and safely store their medication(s) at any Choices office. Antabuse
will be taken by the client and visibly observed and recorded by office and/or counseling staff
within the office hours of a given office or where special arrangements are
made in advance and agreed to by counseling staff during non-office hours. The physician's
prescription regimen and dosage will be strictly followed. If you are required
to submit a urine screen, the urine screen will be given at time requested, with a counslor or other
office staff present. A client is responsibile for the total cost for each
such screen in addition to the contracted amount for Choices Counseling Centers, Inc.
V. INDIVIDUAL THERAPY SESSIONS:
1:1 Therapy sessions are available to clients for a wide range of cognitive, social-emotional, and
mental health services, including case management. In some cases,
1:1 therapy sessions may be elected by the client; in some cases, they may be Court-ordered. All
positive UA's and/or BA's require a client to have an individual
session. Counselors may require a 1:1 if clinically justified, for client to successfully complete.
Client is responsible for all fees. Individual counseling sessions are
billed at Choices current psychotherapy rate. Counselors, therapists, psychologists, or other
mental health clinicians are Independent Contractors and agree to meet
the needs of clients and patients on a by-appointment basis. Please keep all scheduled
appointments. A client must notify Choices in Living Counseling Centers, Inc.
at least 24 hours prior to rescheduling, canceling, or otherwise missing such appointments.
VI. ABSTINENCE:
Abstinence from alcohol and drugs is required for successful completion of any Choices
program.
VII. EXIT
All fees must be paid in full and all classes attended. Credit will not be given for classes with a
balance and a Failure to Complete Discharge will be sent to Probation.
A 30 minute procedure must be scheduled to receive your Discharge and Referral Summary
(DRS). Schedule your exit with the office coordinator after the completion
of your final session.
BY ENTERING MY NAME
and checking the box at the end of this
sentence, I agree to comply with all Choices in
Living Counseling Services policies, rules, and requirements.