Tricia Ace, MFT - Psychotherapy
San Francisco, Walnut Creek
Licensed Marriage & Family Therapist,  #MFC34714
220 Montgomery St., Ste. 318, San Francisco (Financial District)
39 Quail Court, Ste. 305, Walnut Creek (Downtown)
510/205-4748
email: tacemft@gmail.com






              
For future reference, this is a copy of my Information and Consent Form, which you will have agreed to at the beginning of our work together, and which includes the legal limits to confidentiality and my office polcies.

INFORMATION AND CONSENT

1. All information disclosed within sessions is confidential and may not be given to anyone without your permission, except when disclosure is required or permitted by law, as follows:
(a) if there is a reasonable suspicion of child or elder abuse, by anyone, actual or potential;
(b) if you are likely to harm yourself unless protective measures are taken;
(c) if you present a danger of violence to others;
(d) if I am ordered by a court of law to realease information.
In the first three instances, I am required by law to inform the proper authorites and/or potential victims so that protective measures can be taken.

2. Sessions are normally 50 minutes long. We meet one or more times per week, as arranged. Calls between sessions will be returned within 24 hours. In case of emergency, please leave a message on my voice mail and also call your nearest crisis hotline or 911.

3. I request payment at each session. I encourage you to write your check ahead of time so that it will not take time from your hour. If your insurance covers therapy, I will provide you with monthly statements for you to submit for reimbursement. Please note, however, that I am not on any provider panels and do not deal directly with insurance companies.

4. Consistency and continuity are essential to effective psychotherapy. Also, when you schedule an appointment, that time is reserved for you each week. Therefore, it’s important that you keep cancellations to a minimum. If you need to cancel, please do so 48 hours in advance.
I will need to charge your regular fee for appointments missed or canceled with less than
48-hour notice.

5. Appropriate termination of the therapeutic relationship is a gradual, mutual decision involving careful evaluation and closure. Ideally, we discuss options and collaborate on a plan to best meet your needs at that time. In the event that unforeseen circumstances require a sudden decision to terminate, I ask that we meet for at least one closing session.

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