Lemke-Michels · Client Intake

What you are consenting to

• You authorize Lemke-Michels clinicians to assess, diagnose, and provide psychotherapy. You may withdraw this consent at any time.
• You acknowledge the limits of confidentiality: imminent risk of harm, suspected abuse or neglect, or valid court orders may require disclosure.
• You allow Lemke-Michels to release necessary information to your insurer for payment processing and understand you are responsible for fees not covered by your plan.
• You authorize Lemke-Michels to bill insurance benefits on your behalf and assign benefits directly to the practice.

Fee schedule

Telehealth visits use secure audio/video connections to deliver care when you are not in the office. You may choose in-person care whenever it is available. Both you and your clinician agree not to record telehealth sessions without written permission. Keep your environment private and let your clinician know your location and emergency contact at each session. If the connection drops, we will attempt to reconnect by your preferred method. For minors, a caregiver must be available within the home. Telehealth is not intended for emergencies; call 911 or go to the nearest emergency department if you are in immediate danger.

Your Rights

• Receive considerate, respectful care that honors your identity and values.
• Participate in developing your treatment goals and request a change in provider.
• Access your health information and request corrections consistent with law.
• Know about costs, insurance coverage, and alternative options for care.

Your Responsibilities

• Provide complete and accurate information so we can support you effectively.
• Attend scheduled sessions or give at least 24 hours’ notice when you need to reschedule.
• Work collaboratively toward the goals you set with your clinician.
• Let us know if your contact information or insurance coverage changes.