Policies and Procedures

Olive Branch Counseling, Laura Jessen, LIMHP

1. Confidentiality

  • All information disclosed within therapy sessions is confidential and will not be shared without your written consent, except in the following situations:

    • Mandated Reporting: Nebraska law requires me to report any suspicion of abuse or neglect of a child, elder, or dependent adult.

    • Danger to Self or Others: If you disclose an intent to harm yourself or others, I am legally obligated to take protective action, which may include contacting authorities or emergency services.

    • Court Orders: If a court orders the release of records, I am legally bound to comply.

  • Please note that electronic communication, such as emails and text messages, are not entirely secure. Therefore, sensitive information should be shared in person or through a secure portal.

2. Informed Consent

  • Before starting therapy, you will be provided with an Informed Consent Form, which outlines the nature of therapy, potential risks and benefits, confidentiality limits, and your rights as a client. You will be asked to review and sign this document before commencing services.

3. Fees and Payment

  • Session Fees: 30 Minute Session $85

  • 45 Minute Session $100

  • 60 Minute Session $170

  • 90 Minute Session $200

  • If you prepay for Four 60 Minute Session for $600.Payment is due at the time of service.

  • Payment Method: I accept payment by Venmo, Cash App, cash, check, HAS accounts, or credit/debit cards. Checks should be made payable to [Your Name/Practice Name].

  • Cash Pay Practice: My practice operates on a cash pay basis. I do not bill insurance companies, but I can provide a superbill that you can submit to your insurance for possible reimbursement.

  • Clients will be required to keep an active debt or credit card on file for processing lace cancellations and no shows.

4. Cancellation and No-Show Policy

  • Cancellations: Please provide at least 24 hours’ notice if you need to cancel or reschedule an appointment. Failure to cancel within 24 hours will result in a charge of $75.

  • No-Shows: If you do not show up for a scheduled appointment without prior notice, you will be charged the full session fee. Repeated missed appointments may result in termination of services.

5. Termination of Services

  • Therapy is a voluntary process, and you have the right to terminate services at any time. Should I determine that your needs fall outside of my scope of practice, or if therapy is no longer effective, I will discuss alternative treatment options or make appropriate referrals.

  • I reserve the right to terminate therapy if there is non-compliance with policies, non- payment, or other reasons that hinder the therapeutic process. If this happens, I will provide referrals to ensure continuity of care.

6. Crisis or Emergency Situations

  • I do not provide 24-hour crisis services. In the event of an emergency, please contact 911, go to your nearest emergency room, or call the Nebraska Family Helpline at 1-888-866-8660. For ongoing support, you can also reach out to the Nebraska Statewide Crisis Hotline at 1-800-448-3000.

7. Client Rights

  • You have the right to:

    • Be treated with dignity and respect.

    • Ask questions about your therapy and treatment.

    • Receive information about your therapist’s qualifications and approach to therapy.

    • Terminate therapy at any time.

    • Request and review your therapy records, as allowed by law.

    • Report unethical or unprofessional behavior to the Nebraska Department of Health and Human Services.

8. Records and Documentation

  • As required by Nebraska law, I maintain confidential records of all therapy sessions. Records are securely stored for 7 years after the end of treatment, or until a minor client turns 19 years old. After this period, records will be securely destroyed.

9. Teletherapy

  • Teletherapy Services: I offer teletherapy through a secure, HIPAA-compliant platform. By participating in teletherapy, you agree to take responsibility for the privacy of your environment during sessions.

  • Location: Teletherapy is only provided to clients residing within the state of Nebraska. You must be physically located in the state at the time of the session to comply with licensing laws.

10. Minors and Parental Consent

  • For clients under the age of 19, consent for therapy must be obtained from a parent or legal guardian. While parents have a right to access their child’s treatment information, confidentiality between the child and therapist is important for building trust. I will share general progress updates with parents but maintain confidentiality on specific details discussed in sessions, unless there is a safety concern.

11. Ethical Practice

  • I adhere to the ethical guidelines established by the American Counseling Association (ACA) and the Nebraska Department of Health and Human Services. Should you have concerns about my practice, you may file a complaint with the Nebraska Board of Mental Health Practice.

Client Acknowledgment

I have read and understood the above policies of Laura Jessen, LIMHP. I agree to comply with

these policies during my treatment.

Client Name (Printed): ______________________

Client Signature: ___________________________

Date: ____________