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TERMS AND CONDITIONS FOR USE OF INSURANCE

The client/client guardian and insured give Beverly Chevalier LCSW/Monarch Therapeutic Services, LLC permission to obtain and release information to/from insurance carrier for the purposes of coordination of services and payments. The client/client guardian agrees to inform Beverly Chevalier, LCSW/Monarch Therapeutic Services, LLC of any changes to their insurance(s). The client/client guardian agrees to compensate Beverly Chevalier, LCSW/Monarch Therapeutic Services, LLC for any services that their insurance(s) denies payment for. The client/client guardian agrees to pay Beverly Chevalier, LCSW/Monarch Therapeutic Services, LLC in full for any out-of-pocket expenses related to services requested and received that are not covered by their insurance plan(s).

Upon completing and submitting insurance information for the purposed of payment for counseling services received from Beverly Chevalier, LCSW/Monarch Therapeutic Services, LLC, the client/client guardian agrees to the above terns and conditions for the use of insurance to pay for counseling services received from Beverly Chevalier, LCSW/Monarch Therapeutic Services, LLC.

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secondary insurance *

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Therapeutic Life Coaching Disclaimer

THERAPEUTIC COACHING is not psychotherapy, however, it does utilize components of evidence-based psychotherapy interventions such as Cognitive Behavioral Therapy, Motivational Interviewing, and Solution-Focused Therapy. These psychotherapy interventions are integrated with evidence-supported techniques such as Mindfulness, Meditation, Neurolinguistic Programming, Emotional Freedom Technique, Positive Thinking, and Visualization to help clients master attitudes, build skills, and accomplish tasks to reach specific life, career, and/or relationship goals. The Therapeutic Life Coach may very well have the education, training and credentials of a psychotherapist, however, in their capacity as Therapeutic Life Coach, they are not functioning as a clinical therapist.

THERAPEUTIC COACHING sessions are scheduled in blocks of 30 minutes at the discretion of the client. The client accepts that they are responsible for engaging with the coach at intervals that ensure their success within a reasonable time frame as determined by themself and the coach.

Once per week between sessions text or email check-ins and assignment reviews are included in quoted Therapeutic Life Coaching service fees.

TERMS AND CONDITIONS OF SERVICES:
If the client fails to appear for an appointment without a 24-hour notice of cancellation, the session fees will be charged in full. If the client arrives late to their session, the session will end at the time originally scheduled and the client will be charged the full fee for the session. If the client arrives more than 10 minutes late for their scheduled appointment and did not make prior arrangements with the therapist or coach, their appointment may be forfeit. If the appointment is forfeit, the client will be charged the full fee for the session. Services outside of those specified in this agreement (including, but not limited to, phone calls, emails, record reviews, and professional consultations) are the client’s responsibility. These services will be billed at $25 per 15 minute increment.

UPON SUBMITTING THIS FORM THE CLIENT/CLIENT GUARDIAN AGREES TO THE ABOVE TERMS AND CONDITIONS OF SERVICES *

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