Office Policies & Procedures
Breanna Fischer, LMHC
Peregrine Counseling Services
9340 NE 76th St
Vancouver, WA 98662
(360) 798-0004
www.peregrinecounseling.com
Welcome to Peregrine Counseling Services!
As a Licensed Mental Health Counselor of the state of Washington (LH 60237306), I am
providing the following information to notify you regarding the practice at Peregrine
Counseling and to inform your course of treatment. Please feel free to ask questions
about any of the statements provided. You have the right to control your own
treatment.
Counselor Education & Training: I earned my Bachelor's Degree at Warner Pacific
College in 2003, and went on to obtain my Master's Degree in Marriage and Family
Therapy at Fuller Theological Seminary in Pasadena in 2005. In 2011, I became
licensed as a professional Mental Health Counselor in the State of Washington. With
nine years of experience working with children, adolescents, and adults, I have
worked in schools, residential treatment centers, and outpatient settings, as well as
on-site, in-home, and community locations. I am certified as an instructor in The
Incredible Years parenting program and am currently pursuing certification in Play
Therapy. Other training/specialties include: Grief & Trauma, Sexual Behavior
Problems, ADHD, Anxiety, Anger Management, Abuse/Neglect, Foster Care &
Adoption, Adjustment Disorders, and Depression.
Therapeutic Orientation: When I first meet with clients, I like to begin by spending
time getting to know them as a person and hearing their story. I feel our therapy
sessions should be a safe, respectful place that provides for your self-expression and
growth. Together we can discuss and explore the problems you are experiencing and
you can formulate your own goals for the therapy. My role as a therapist includes
offering you (or you and your child, or your family) active listening, reflection,
encouragement, helpful challenges, and constructive feedback. I often utilize
motivational interviewing, experiential exercises, family system dynamics, and
cognitive behavioral techniques during sessions.
Fee Schedule:
Initial Session/Assessment: $90
Individual or Family Session: $75
Play Therapy Session with Follow-up Phone Call: $80
The therapy hour is approximately 50 minutes long (unless otherwise arranged), with
the remaining 10 minutes set aside for record keeping.
Insurance: I am a provider for several types of insurance. If you provide me with your
insurance information, I would be happy to bill your insurance. I can also bill as an
Out-of-Network Provider for other insurances. Please be aware that you may have a
deductible to meet or a co-pay as part of your insurance coverage. Co-pays and cash
payments are due at the time of service. You are responsible for any portion of your
bill that your insurance does not pay.
Cancellation Policy: In order for the therapy process to be effective it is important to
keep regular appointments as scheduled. Appointment times are set aside specifically
for you, and are difficult to fill with late notice of cancellation. Therefore a 24 hour
notice of cancellation is required for sessions that will be missed. Sessions that are
missed without a 24 hour notice will be billed at full charge. If you are late to your
appointment, please call and I will wait for you.
Emergency: I attempt to respond to my messages or texts within 24 hours. If you
need help sooner or if there is a life-threatening emergency, call Clark County Crisis
Line (360-696-9560), call 911, or go to the nearest hospital emergency room.
Confidentiality: Psychotherapists are bound by their professional code of ethics and
state law to keep what you discuss with them, including the fact that you have
consulted with them, strictly confidential. Confidentiality laws provide that
information can be revealed only under the following conditions:
1. With your written permission.
2. If you are an immediate danger to yourself or others, or are unable to attend to
your basic needs (i.e. suicidal, homicidal, or unable to take care of yourself).
3. Suspected child abuse or neglect cases must be reported to Washington
Department of Child and Family Services, or Oregon Children’s Services Division.
4. If we are ordered by a court to release information.
5. The fact that you have received services is unavoidably revealed if your account
becomes delinquent and is referred for collection.
Your Client Rights: As the client, you have the right to request changes in treatment,
ask questions about your treatment, and end your treatment at any time. You also
have the following rights:
1. To expect that a licensee has met the minimal qualifications of training and
experience required by state law.
2. To examine public records maintained by the Board and to have the Board confirm
credentials of a licensee.
3. To obtain a copy of the Code of Ethics.
4. To report complaints to the Board;
5. To be informed of the cost of professional services before receiving services;
6. To privacy as defined by rule and law, including the exceptions to confidentiality of
information obtained in the course of services which are stated above in the
Confidentiality section;
7. To be free from being the object of discrimination on the basis of race, religion,
gender, or other unlawful category while receiving services.
For additional information or to make a complaint you can contact the Dept. of
Health, Professional Licensing Division, PO Box 90432 Olympia, WA.
Consent: I have read and understand all the information provided in this disclosure
statement. I hereby give my consent for treatment. I have been provided a copy of
this Client Consent and Disclosure Form, Privacy Practices.
Client Signature (over age 13) _________________________________ Date _______
Guardian Signature __________________________________________ Date ________
Counselor’s Signature ________________________________________ Date _________