THOMAS ROE, PSY.D.
Welcome to my office at Rainier Associates. The following information is provided to familiarize
you with my practice and background.
CREDENTIALS: I am a licensed clinical psychologist in Washington and California. I was born
and raised in Tacoma, WA. I completed my undergraduate education at the University of Puget
Sound and my professional training at the Washington School of Professional Psychology. I
completed my predoctoral internship at the University of Idaho and my postdoctoral residency at
the University of California, Davis. I spent six more years at UC Davis as Coordinator of Graduate
Student Counseling Services before joining Rainier Associates. I am also an adjunct professor at
Middlebury Institute of International Studies at Monterey.
APPOINTMENTS: Your appointment time is held exclusively for you. It is important that you
arrive on time for your appointment, as it cannot be extended. If you are unable to keep your
appointment for any reason, please contact the office at least 24 hours in advance to cancel or
reschedule; otherwise, you will be charged $50 for the missed session. Insurance will not pay for
missed sessions; you will be responsible for the charge. If a pattern of no shows/ late cancellations
occurs, our working relationship will terminate, and you will need to obtain care elsewhere.
PROCESS OF THERAPY: I provide individual and couples counseling (18-65 years old). I am
also open to providing outreach including presentations, workshops, and training to various groups
in the community. My professional interests include stress/anxiety, depression, peak performance,
eating disorders, substance abuse/addictions, relationship issues, adjustment, trauma and
intersections of identity and culture. I consider myself to be a generalist with recent experience in
higher education working with undergraduate and graduate students, medical/law students, and
those hoping to improve focus, attention, motivation, and work efficiency.
I consider social justice an important piece of my work striving for equity and social opportunity.
I use a wide variety of collaborative approaches in therapy, depending on the nature of the work,
identities present in the room, and cultural considerations. I enjoy being creative using a variety of
interventions including cognitive-behavioral therapy (CBT), psychodynamic, humanistic, and
feminist modalities. I utilize the relationships in the room, motivational interviewing, mindfulness,
and interpersonal process to further personal development and positive change. I tend to use a
casual and open approach to the therapy process and appreciate humor. My overall goal is to help
individuals maximize their life potential and thrive.
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EMERGENCY CALLS: An answering machine takes all emergency calls outside of regular
business hours. If it is a true emergency (self- harm or harm to others) I would suggest calling 911
or the pierce county crisis line at (253) 798-4333.
BILLING AND PAYMENT: Patients, or their responsible legal guardians, are responsible for
their accounts and are expected to pay their bill when due, whether medical insurance pays for a
portion or not, including charges for evaluation, printed materials, reports, letters, consultations
and telephone calls. A finance charge of 1% per month may be added to any balance not paid
within 60 days after the charge was incurred. When 90 days have passed without a payment,
accounts may be sent to collections and the patient or legal guardian may be responsible for any
additional legal and/or collection agency charges. Results of evaluations or reports may not be
released until accounts are paid in full. I understand that this is an expensive treatment and I am
prepared to arrange an extended payment plan. This entails a written agreement to pay a fixed
amount regularly each month until the balance is paid. If regular payments stop, the balance will
be considered delinquent, and finance charges and collection procedures may be instituted.
Bills are sent out monthly and detail the dates of visits, the type of service provided, whether your
insurance company had been billed for that visit, and all payments made into your account. If you
have any questions about your bill please contact our billing department.
You are expected to pay for each session at the time it is held, unless we agree otherwise or unless
you have insurance coverage. If you have insurance coverage you are expected to pay your co-pay
at the time of each appointment. If you are uncertain about your co-pay I encourage you to contact
your insurer. If you have any other questions on this matter I would suggest asking our office staff.
INSURANCE: I am a contracted provider for many, but not all, local insurance companies. You
should be sure to check with your insurer and my intake office to learn whether I am a provider for
your plan. You should also learn whether you need a referral or preauthorization in order to be
eligible for your mental health benefit, whether you have a separate annual deductible for mental
health, and whether your mental health benefit has a maximum yearly number of visits or a
maximum yearly dollar amount. My billing department will submit claims to insurance companies
that I am contracted with. In order for this to occur you must complete the insurance portion of the
“Patient Information” form that was given to you with this office policy. You also need to provide
a copy of your insurance card.
CHANGES TO THIS OFFICE POLICY: From time to time I may change the business policies
described in this document. I will attempt to notify you of relevant changes
INFORMED CONSENT: your signature below indicates that you have read the information in this
document and agree to abide by its terms during our professional relationship.
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INFORMED CONSENT FOR ADULTS: I hereby authorize Thomas Roe Psy.D. a licensed
psychologist, to render psychological services to ________________________. This authorization
constitutes informed consent without exception. I have read and understand the office policy
statement and notice of privacy practices and have received a copy of this office policy for myself.
Date_______________Signature_____________________________________________________
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