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All information that you share in therapy is held in confidence and will not knowingly be shared with another medical person without your written consent with legal exceptions as listed in Privacy Practices. There is a vulnerable aspect in all faxes, electronic communication devices, and computers that MAY NOT BE PREVENTABLE, regardless of safeguards. Please review these forms; Notice Intake, Privacy Practices, Consent for Release of Confidential Information.

In the case of an emergency or if you believe you or someone close to you is a danger to yourself or others, please call 911. Other helpful crisis phone numbers that are available 24 hours a day:

Family Violence Prevention Services (210)733-8310

Rape Crisis Center of San Antonio (210)521-7273

Runaway Hotline of Texas 1-888-HELP (4357)

Suicide Hotline 1-800-SUICIDE (784-2433)

TDFPS (Texas Department of Family & Protective Services) 1-800-252-5400

Acorn Counseling is not a 24 hr operating service and appointments are scheduled.

Initial fee of $120, subsequent individual sessions $120, couple/family session $120 when billing insurance are due at the beginning of each session. Cash or personal checks to Acorn Counseling PLLC, debit or credit cards are acceptable for payment. There is a discount for cash payment in full, and a $30 fee for returned checks. Please note that fees are subject to change and negotiated before payments are due. Clients or Guardians are responsible for full payment of fees, regardless of insurance company policies. Clients are responsible for notifying this office when their insurance changes, and following through with their insurance account adjustments. Consistency is an important part of the counseling process, and the appointment time that you schedule is reserved for you; it is not available to anyone else. Once an appointment has been scheduled, you will be expected to pay for it unless you provide notice of cancellation at least 24 hours in advance or were unable to attend due to circumstances beyond your control. Messages received on my answering system are acceptable for prior notice. Sometimes it may be necessary for me to reschedule an appointment and I will make every effort to contact you in advance to do so. A fee of $60 will be assessed if short cancel or no show is avoidable. Professional services such as consulting, talking with attorneys or other providers, creating treatment summaries, or records preparation are $60 payable prior to services delivered. I require a $500 retainer prior to action for legal documents or court appearances. I will not accept any gifts. Copies are $1 per page.

As of September 1, 2010, Susan Loveland, LPC will not have therapeutic involvement in ongoing custody cases or cases that may lead to civil court hearings for the purposes of determination of custody. She will provide referrals for counseling and social studies. If a client/family/attorney does send or initiate a subpoena, the client/family/attorney will be responsible for paying a $500 flat fee (in Bexar County) once the subpoena has been received, whether there is any testimony or not. This fee must be paid with a credit/debit card. Outside of Bexar County the $500 fee applies, and there will be $.60/mile up to 75 miles. Records also must be paid for by each party.

The therapist will play no active role in divorce/custody proceedings or share specific information that either party who confides during individual therapy sessions. The therapist’s role will be to facilitate communication between members for reconciliation, and not serve as a witness for either party. It is unethical for me to do any forensic evaluation during the course of treatment. A complete printed copy of the custody agreement for children of divorce or have custody arrangements is required before sessions begin.

EFFECTIVE JUNE 1, 2013, SUSAN LOVELAND IS HEREBY
APPOINTED AS THE HIPAA PRIVACY COMPLIANCE OFFICER. IF YOU ARE CONCERNED THAT YOUR PRIVACY RIGHTS HAVE BEEN VIOLATED, OR YOU DISAGREE WITH A DECISION MADE ABOUT YOUR ACCESS TO YOUR RECORDS, YOU MAY CONTACT SUSAN LOVELAND, LPC, AT 830.331.4032, 109 ENTERPRISE PARKWAY SUITE 201 BOERNE TX 78006 OR SECRETARY OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES OFFICE OF CIVIL RIGHTS 200 INDEPENDENCE AVENUE S.W. WASHINGTON DC 20201 202.619.0257 TOLL FREE 1.877.696.6775 ALSO NOTE: THIS ENTITY MAINTAINS HEALTH RECORDS IN ELECTRONIC FORMAT AND ELECTRONIC PROTECTED HEALTH INFORMATION (e-PHI) AND IT IS NOT DISCLOSED WITHOUT PROPER AUTHORIZATION IN WRITING.