Ann Palik, MA, MFT

 

helping close the gap between where you are,

and where you want to be.

 
   
 
 

"And then the day came, when the risk to remain tight in a bud was more painful than the risk it took to blossom. "

- Anais Nin:

 

Before Your First Session:

When we meet for the first time, I will ask you to complete some standard forms, some of which you may have seen at your doctor's office.  Your answers will help me to help you.  But most of the forms provide information to you about my office polices and your rights under the law. 

If you wish, you may download and complete these forms (see below) in advance and bring them to our first meeting. 

Forms:

(1) Personal Info

(2) Informed Consent

(3) Limits of Confidentiality

(4) Acknowledgment of Receipt of Notice of Privacy Practices

(5) Notice of Privacy Practices

 

Services Offered:

Individual therapy: $120 for a 50-minute session

Couples therapy: $160 for a 90-minute session

(I'm also occasionally able to offer a sliding-scale fee.)

Insurance:

I accept Aetna PPO/HMO/EAP, Blue Shield/Magellan PPO/HMO, Cigna PPO/HMO/EAP, Coastwise ILWU, ComPsych, Horizon Health, MHN (HealthNet), and TriCare insurance, along with PPO's from other plans.  

Policies:

1.  I offer psychotherapy sessions on an ongoing weekly basis, biweekly, or monthly basis.  Payment is due at each session by cash or check. 

2.  All regularly scheduled sessions are your financial responsibility.  If you cannot attend a scheduled session, it is your responsibility to give me at least 24 hours’ advance notice.  If you cannot give 24 hours’ notice, I will make reasonable efforts to reschedule your session during that same week, depending on my availability.  If this is not possible, you will be charged for the missed session. Since insurance companies do not reimburse for missed sessions, you will be responsible for the full fee for the missed session, not just the co-payment.

3.  Either of us may end the therapy.  I would like to offer emotional support in all phases of your therapy, including its ending.  If you give me a few weeks’ notice before leaving, I can best help you leave well, with a sense of completion.

4.  If at any time you feel that you are not getting what you want out of our sessions, please let me know so we can discuss your needs and adjust your treatment plan.

5.  The information you disclose to me is generally confidential.  I will only release information about our work together, including the fact that you are in therapy with me, with your written authorization or if required to do so by court order.  There are some situations in which I am obligated to breach your confidentiality to protect you or others from harm.  These include: (1) if I have information that indicates a child or elder or dependent adult is being abused; or (2) if a client makes serious threats of violence against another person, or when a client is dangerous to him/herself or the person or property of another. 

6.  If you are using your insurance to cover some of your therapy costs, the insurance company will require--at a minimum--diagnosis and session dates, and may also require a written progress report and treatment plan.  When you sign your insurance claim form, you waive your right to confidentiality and grant the insurance company access to these records. 

Getting Started:

Getting started is as easy as calling me at (310) 538-3512, or e-mailing me at ann@therapy-conscious.com, to arrange an initial phone conversation to discuss how I can be of assistance to you. 

 
 
           
       

Ann Palik, MA, MFT

Licensed Marriage and Family Therapist

Individual, Couple, and Group Counseling in Torrance, CA

(310) 538-3512

ann@therapy-conscious.com

 
           



 

NOTE: This website is intended only to provide general information about Ms. Palik's scope of practice
and qualifications as a licensed marriage and family therapist in the State of California. She does not
conduct online therapy at this time. Furthermore, no therapeutic (i.e., therapist/patient or
therapist/client) relationship with any person is created, intended, or implied by the use of this website.

COPYRIGHT 2011, Ann Palik, MA, MFT