PROVIDERS FOR HEALTHY LIVING
INFORMED CONSENT FOR TREATMENT

Services Offered 

Providers for Healthy Living offers the following services:  

• Medication management by licensed medical professionals 
• Psychotherapy/counseling by licensed counselors and social workers
• Psychological testing/evaluation by licensed psychologists
• Weight loss consultations and therapy by licensed obesity medicine specialists

Medication management is assessment and evaluation of mental health problems and uses a combination of medications and psychotherapy to alleviate these problems. Medication  management works best when it is done in collaboration with psychotherapy. Medication  management sessions usually last 15 to 30 minutes (after the initial evaluation session), and are scheduled as often as clinically appropriate.  

Counseling/therapy is a collaboration between you and your therapist for the purpose of addressing personal, relational, and/or mental health problems. It consists of confidential disclosure, support, diagnostic information, other forms of feedback, a plan of treatment, ideas for possible alleviation of your concerns, encouragement for important behavioral changes, strategies for managing difficult relationships, suggestions for reading and education, referrals to other helpful professionals when needed, etc. Therapy sessions usually last 40 to 60 minutes and are scheduled weekly, bi-weekly, or monthly.  

Psychological evaluation takes time and is a collaborative process. The more information you provide, the more accurate the results will be. As with any medical procedure, there are risks involved. We will discuss any concerns you have about information requested.  The information gathered will be integrated with the test results obtained, and an assessment and recommendations will be provided. Your treatment provider will work with you to incorporate these into your treatment plan, as is clinically appropriate.  

Weight loss consultations and therapy involves assessment of previous and current eating habits, weight loss attempts, exercise, thoughts that impact eating and nutrition, mental health symptoms impacted by and that are impacting eating, and establishing goals for weight loss.  A plan for weight loss can include therapy, nutrition interventions, physical activity changes, medications, or all of these.

Here are some important things to know about your treatment:  

• We are professionals. The treatments we provide are supported by research, and we only use techniques, assessment tools, and strategies in which we are trained. We maintain ongoing professional development, and strive to keep abreast of the latest research in our field. You can ask to review our professional qualifications at any time. 
• Consistency is important. Attending regular appointments is the best way to help yourself reach your goals. 
• There are risks involved. It is not uncommon for behavioral problems to get worse before they get better. Sometimes when painful memories are uncovered, it brings back unwanted feelings. Medications sometimes have unwanted side effects. We will discuss all of these risks with you during sessions, and the decision to proceed is always yours. We welcome and value your feedback at every step along the way, and will always take this feedback into consideration to help determine the next step  of treatment. 
• Healing takes time. Problems that take years to develop can often take months or years to resolve. Be patient, and give it a chance to work. The first approach  sometimes doesn’t work. With your feedback, we can make adjustments to your treatment plan to address your concerns. 
• While we will do our absolute best to help you improve your situation, we cannot guarantee that you will achieve the outcome you want. 
• You have the right to end services or not follow our recommendations whenever you choose.

Confidentiality 
What you disclose is kept confidential, as it is one of the essential elements of an effective  therapeutic relationship. At times, you may choose to give us permission to disclose confidential information. For example, you may want us to consult with your family doctor, key family members, or other important people in your life. This permission will be given in writing, and you will specify who can receive the information. We are fully committed to maintaining confidentiality except in cases where intervention is a professional or legal mandate, including, but not limited to the following:  

• If you are a danger to yourself or someone else. If you are threatening to harm yourself or someone else, we are obligated to do what we can to keep that from happening. This includes alerting others or trying to contact the intended victim. (This does not mean, however, that every time suicide is mentioned in session we will take outside action.) 
• In cases of abuse. It is our duty to report actual or suspected child abuse/neglect and  vulnerable adult abuse/neglect. 
• In cases of a court order. Sometimes a judge orders us to disclose information if it is  important to a court case. We are required to follow these orders. 
• When you want your insurance company to reimburse us for services. As with all medical care, your insurance company may request clinical information before paying for your outstanding claims. 

For clients under eighteen, both parents have the right to know what occurs in appointments without a release of information. If you are a parent of a child, we would strongly advise you to allow much of what your child says to remain confidential. Even though you are entitled to it, insisting on information will likely damage our professional relationship with your child and could lead to regression in treatment. We will be happy to keep you informed about how treatment is progressing, and what you can do to support your child throughout treatment.  

Crisis Situations 
In the event of a mental health emergency or crisis situation, there are options for you. In the event of a crisis, you must take action, as your therapist or psychiatric provider may not be immediately available.  

• Call 911 or proceed to the nearest hospital emergency room 
• Call the suicide hotline: 988
• Aspire Health Partners offers 24/7 walk-in emergency assessments at 1800 Mercy Dr, Orlando, FL 32808 
• After taking action, call to make us aware of the situation. It is rare that we will be immediately able to see a client in crisis, so we strongly encourage you and your family to have a plan in place so you know what to do if a crisis occurs. We will do everything we can to support you if you are in crisis.  

Technology Use and Limitations 
As a technology-driven office, we rely on electronic forms, email, virtual phone and fax services, electronic medical records, electronic insurance verification, electronic billing, and electronic payment services. In order to interact with us, it is necessary to have the appropriate technology. However, traditional methods of contact (mail, phone, and in-person) are also available, as are traditional payment methods (cash and check). We provide the required electronic devices in the office to complete forms and surveys. There are paper versions of all our forms and chart notes in the case of a technology failure. Our goal is to respond to all emails, voice messages, text messages, and faxes within 24-hours. After hours emails, text messages, and faxes are not monitored and our on-call provider only monitors the emergency phone messages. Patients are free to contact the office between appointments using their preferred method - phone, email, text, in-person, and/or fax. Caution should be used when using public or work computers to avoid inadvertently sharing your personal health information.

Virtual/Online Treatments
Virtual/online treatment brings a new set of informed consent considerations that includes the following:

• Identify Verification - All patients will have to verify their age and identity by showing their drivers license or other verifiable governmental identification.
• Technology - Providers for Healthy Living's online providers will use HIPAA compliant video services. The patient is responsible for securing his or her own computer hardware, internet access points, and password security.  Providers for Healthy Living is not liable for confidentiality breaches when they are caused by patient error.  Providers for Healthy Living is not responsible for their patient’s equipment failure, e.g. camera, and/or internet service.  Providers for Healthy Living is not responsible for lapses in confidentiality that are in direct response to the patient's actions.
• Disconnection Problems - If video services are not available due to an unplanned equipment or service malfunction, sessions will occur via telephone.
• Recordings Are Prohibited - Patients are not allowed to make an audio or video recording of any portion of the session.
• Risk of Harm - Online mental health treatment is not a crisis-based clinical service.  Online mental health treatment may not be appropriate for patients with active suicidal or homicidal thoughts or patients who are experiencing acute mental health problems, such as manic or psychotic symptoms.  It is the responsibility of the patient to inform their Providers for Healthy Living clinician if they are at risk of harm to self or others.  At intake, a patient who reports being at risk of harm to self or others will not be offered online mental health services from Providers for Healthy Living.  If through the intake evaluation or subsequent sessions, a patient is deemed to be at risk of harm to self or to others, Providers for Healthy Living will terminate the sessions, while providing alternative treatment options.  If a patient who was not formerly at risk should become at risk of such harm to self or others, they must immediately report it to their Providers for Healthy Living provider.  In such cases, a patient may be referred to a traditional program or provider.
• Confidentiality Restrictions - The laws that protect the confidentiality of any medical information also apply to online mental health treatment.  Information about the patient will only be released with his or her express written permission, with the exceptions of the following cases:  (1) if the provider determines risk of self-harm, (2) if the provider determines risk of harm to others, (3) if the provider is informed about or suspects abuse, neglect, or exploitation of a minor or of an incapacitated adult, or (4) if the provider believes that someone’s mental condition leaves the person gravely disabled.
• Records - The provider will maintain records of online treatment and/or consultation services. All clinical records will be maintained as required by applicable legal and ethical standards according to the various professional licensing boards, i.e. American Counseling Association, National Association for Social Workers, American Medical Association, American Psychological Association, etc.
• Patients have the right to refuse consent or withdraw consent for treatment at any time by informing any staff member.