Office Policies Agreement

Please type your initials after each of following statements below in the box provided on the right to indicate that you have read and understand our office policies.

Cancellations:

If you wish to change a scheduled appointment, it is important to provide at least 24 hours’ notice, or you will have a strike against your attendance.

Exceptions to this are: physical illnesses, personal or work emergencies, or an unanticipated circumstance, which could reasonably be called an “emergency”. If two appointments are missed without proper notification, then your therapist will notify you to discuss these concerns. Medi-Cal recipients will not be billed.

Tardiness:

Should you arrive 15 minutes late, or more, you are considered tardy and therefore forfeiting your session. A forfeited session is considered a missed appointment (no-show).

If a Care Provider is given permission to leave the client during the scheduled appointment, they must be back in the office to pick up the client before session is over.

Missed sessions/ no shows:

If you are a Youth Link client, CPS will be notified of every missed appointment. In the event of two missed appointments that are not cancelled within 24 hours, you will be at risk for termination from all services. A continuous pattern of cancellations, missed sessions, or tardiness may also constitute early termination from all services and other arrangements will be made. Termination from services will ultimately be determined by the therapists.

The Psychiatrist:

Psychiatric services are in high demand resulting in a limited number of appointment times being available. If two missed appointments occur, you will be at risk of being terminated from Medication services. Please remember that managed care requires monthly visits from the psychiatrist for those who are prescribed medication. If you are not seen by the psychiatrist on a monthly basis, services may be terminated. Also, if you are not seen within 30 days by your therapist, case manager, or psychiatrist then services may be terminated.

Telephone Availability:

Telephone calls are usually returned within 24 hours during normal business hours. When leaving a message please state your name, the client’s name, phone number, and best times to be reached. In the event that your call is not returned in a timely fashion, please do not hesitate to call again. We will do our best to return your call within the next business day. Occasionally answering machines malfunction, and your first call may not have registered for one reason or another.

Emergencies:

In case of emergency (such as harm to self, harm to others), please contact Emergency Response Services at 911. California Psychological Institute (CPI) does not provide emergency services. If the client reports a desire to harm self or others while participating in services with CPI staff, staff may be required to contact Emergency Response Services such as the COPE Team or the Fresno Police Department. Please see resource list included at time of intake or provided from your therapist for additional numbers.

I HAVE READ AND AGREE TO THE TERMS OUTLINED ABOVE: