UPDATED CONSULTATION CONTRACT
Although I am a licensed psychologist in the state of California and Arizona, the consultation services that I am providing you do not fall under my practice as a licensed psychologist. Therefore, I am not practicing in my role as a licensed psychologist with you nor am I practicing psychology as it is defined by law in the state of California.
I will not diagnose you nor will I treat psychological or medical disorders. I am offering you consultation in your self-development, support in your spiritual evolution, intuitive readings of your energy field, subtle energy work, and, if appropriate, mentoring in the practice of the healing arts. You are free to discontinue your work with me at any time. You are free to participate or not as you wish in any of the workshops I offer subject to my approval and any pre-requisites that may be necessary for attending.
CONTACT INFORMATION: There are several ways that you can contact the office of Dr. Fields:
* You can call Dr. Fields at 415-507-9950.
* For messages that are private for Dr. Fields, you can leave them on 415-507-9950.
*Text messaging is for last minute consultation changes or emergency texts only. Please do not test otherwise. Use email for the quickest way to communicate with Dr. Fields
If you have already scheduled a consultation, the designated phone number to reach Dr. Fields at the appointment time for the phone consultation is 415-507-9950. All other ways to meet for a consultation can be found on the website under About, and then Contact.
PAYMENT FOR SERVICES
Clients are expected to prepay for services at the time they confirm an appointment slot. All fees are negotiated in US currency. Prepayment by credit card occurs at the time of scheduling the appointment through the on line scheduler at www.spirit-evolving.com
Please Note: All sessions scheduled via the online scheduler will have a 72 hour cancellation policy with full payment due for cancellations without such notification. Due to the time it takes to fill last minute consultations, it is possible you will be charged for your session even if your cancelled space is filled. There are no refunds for telecalls or other class registration as these are taped and available for you to listen to at any time.
Updated session fees for individuals, couples, families, groups and telecall classes are listed on the website, www.spirit-evolving.com
Dr. Fields does not provide services that are reimbursed by insurance companies.
All information disclosed within sessions is confidential and may not be revealed to anyone without written permission except where disclosure is required by law. Disclosure may be required in the following circumstances: Where there is a reasonable suspicion of child abuse or elder adult physical abuse or dependent abuse; where there is a reasonable suspicion that the client presents a danger of violence to others or where the patient is likely to harm him or herself unless protective measures are taken.
Disclosure may also be required pursuant to a legal proceeding. Dr. Fields may occasionally find it helpful to consult about a case with other professionals. In these consultations, Dr. Fields makes every effort to avoid revealing the identity of the client. Unless you object, Dr. Fields will not tell you about these consultations unless she feels that it is important to your working relationship. Please be advised that Dr. Fields does hire office staff who assist with the administrative details of her practice including filing, billing, correspondence and record keeping. If you have a concern about the confidentiality of your client information, please feel free to discuss this with me.
Dr. Fields is generally in the office for portions of Monday through Friday. If you have an emergency, please call the emergency room of your local hospital and ask for the psychiatrist on call or call your family physician for care. If you call Dr. Fields for an emergency, she will get back to you as soon as is possible. Please see below for more detailed information on Dr. Fields's policy for returning calls. If you anticipate a need for emergency consultations or will be requiring frequent contact in between your sessions, then please be advised that Dr. Fields would not be suitable as a consultant for you. If you need to contact Dr. Fields between sessions, please email her. Email is the quickest way to get a hold of her. She is generally not available evenings or weekends.
Phone calls/email responses between sessions will be charged at the regular rate. If you feel you cannot wait to reach her, please call your family physician or the emergency room at the nearest hospital and ask for the psychiatrist on call. Most often, her assistant will have names of other consultants whom you might contact in her absence.
EMAIL COMMUNICATIONS PERMISSIONS
By electronically signing the form below, I agree that I will be placed on Patricia Fields, PsyD mail list where I can receive a Welcome Package, monthly newsletters, updates, and event notices. Communication emails will have an option for you to unsubscribe.
Furthermore, in consideration of receiving services rendered by Dr. Fields,
I hereby declare as follows:
*That my true and legal name is as signed below and not otherwise.
*That Dr. Fields has informed me that she is not functioning in her role as a licensed psychologist nor as a medical doctor and I am aware that she is not licensed under laws of this state to practice any form of medicine.
* I understand that Dr. Fields evaluates the subtle energy field and works with it as well as other forms of self development interventions.
* I understand that subtle energy work is in an experimental stage and that reading subtle energy fields is not always historically accurate and that information provided as a result of this work should not be taken literally, is subject to change and should be taken as only one piece of information in any decision making situation.
* I understand that any memories that are retrieved through this process by Dr. Fields or myself may not necessarily reflect historical accuracy.
* I understand that following my sessions with subtle energy work, I may feel slightly disoriented or fatigued which generally responds to rest. If I experience any usual reactions, I will notify Dr. Fields who will return a call at her earliest convenience.
* I understand that these calls will be billed at the usual billing rate.
* I understand that Dr. Fields has stated that she will neither diagnose nor prescribe for any condition or problem from which I may appear to be suffering.
* That Dr. Fields has suggested that should I have any medical complaints I should consult a medical practitioner.
* That Dr. Fields has informed me and I understand that no guarantees or promises of cures have or will be made to me and that any benefits which I experience come from within my own self.
* That I am 21 years of age or older.