Private practice open to new clients with permission only;
SCOTLAND PICTURES ARE POSTED
UPDATED CONSULTATION CONTRACT
PATRICIA FIELDS, PSYD
NATURE OF CONSULTATION SERVICES
Although I have professional training as a psychologist and hold a psychologist license in Arizona and an inactive psychologist license in California, the services I provide through this practice are offered as consultation, education, personal and spiritual development, and energetic practices and intercessions. These services are not provided in my capacity as a licensed psychologist.
Our relationship is a consultative relationship and is not intended to establish a psychologist-patient or psychotherapist-client relationship. I do not provide psychological diagnosis, psychological testing, psychotherapy, or treatment of psychological, psychiatric, or medical disorders through this consultation practice.
The services I offer may include consultation and support in personal and self-development; support for spiritual development and evolution; discussion of emotional concerns, relationships, life transitions, and other matters relevant to your personal or spiritual development; intuitive readings of the energy field; subtle energy practices and energetic intercessions; educational and experiential practices; and, when appropriate, mentoring in the practice of the healing arts.
Energetic, intuitive, spiritual, and healing-arts practices are offered as part of my consultation and spiritual-development work. They are not represented as psychological, psychiatric, or medical diagnosis or treatment and are not intended as substitutes for psychotherapy, psychological treatment, psychiatric care, medical care, or other licensed healthcare services. You are responsible for obtaining appropriate professional healthcare or mental-health services when needed.
You are free to discontinue your consultation work with me at any time. You are also free to participate or decline to participate in any particular practice or intervention offered during consultation. Participation in workshops that I offer is voluntary and may be subject to my approval and to any prerequisites established for a particular workshop.
Nothing in this agreement is intended to waive or limit any rights or obligations imposed by applicable law.
CONTACT INFORMATION:
There are several ways that you can contact the office of Dr. Fields:
* You can call Dr. Fields at 415-507-9950.
* You can email to patrice@spirit-evolving.com or fieldspatricia@comcast.net
* 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
OUT OF SESSION CONSULTATIONS AND COMMUNICATIONS
Communications outside of scheduled consultation sessions from clients to Dr Fields that require a response, will incur a fee billed at the rate of 15 minute increments. In particular, this refers to any questions that require an intuitive reading or substantive response. Generally speaking, these kinds of communications will require booking session time as Dr. Fields cannot guarantee a response by text or email or phone. Please direct all communications via email unless you are informing Dr. Fields of a schedule change that occurs at the last minute, in which case both emailing and texting is recommended.. Communications regarding schedule changes do not incur a fee although all schedule changes can be made on the online scheduler by the client.
CONSULTATION RELATIONSHIP MANAGEMENT
Any and all concerns/conflicts, feelings, issues regarding the consultation relationship itself are to be communicated in session and are considered as part of billable hours and time. Dr. Fields does not read or response to texts, emails or phone calls where clients voice concerns, conflicts, feelings or issues as to the consultation relationship. And and all of these communications are considered to be an integral part of the consulting relationship. This similarly applies to groups, where any and all issues related to group dynamics are to be communicated in paid group session time and not through texts, emails or phone calls to Dr. Fields and/or to the group members. Treatment planning and/or termination conversations and closure are considered as part of billable hours.
CREDIT CARD DISPUTE MANAGEMENT
By signing this agreement, you agree to contact Dr Fields and or her professional support to attempt to mediate any credit card charge issues before you file a dispute.
Once you file a dispute, you relinquish your confidentiality rights and by signing this contract you understand that Dr. Fields is entitled at that point to release whatever documentation Dr Fields deems is necessary to file as evidence to counter the dispute.
CANCELLATIONS
Please Note: All sessions scheduled via the online scheduler will have a 48 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. Clients are responsible for their own cancellations and re-booking and can do so by going to the appointment confirmation email and clicking at the bottom on Change/Cancel appointment. By doing this procedure, a cancellation of one appointment occurs and a re-booking of a new time occurs without incurring credit card changes. Clients may be charged the credit card billing fee if they cancel an appointment that they actually wish to change and then re-book the new appointment separately. This incurs double credit card charges for which the client is responsible.
SESSION FEES
Updated session fees for individuals, couples, families, groups and telecall classes are listed on the website, www.spirit-evolving.com
INSURANCE REIMBURSEMENT
Dr. Fields does not provide services that are reimbursed by insurance companies.
CONFIDENTIALITY
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.
Please note that confidentiality rights are also relinquished under conditions of credit card disputes.
EMERGENCY PROCEDURES
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.
PRACTICE CLOSURE UPON INCAPACITY OR DEATH
In the event that I become permanently incapacitated or die and am therefore unable to continue my consultation practice, a person or professional service designated by me will be authorized to take the limited steps necessary to close my practice in an orderly manner. This may include notifying clients and members of my professional community, responding to reasonable administrative inquiries, providing information concerning possible resources for continued support, and arranging for the secure disposition of consultation records and client information.
Notification and Follow-Up Resources.
In the event of my death or permanent incapacity, a general notification may be sent to my clients and professional community informing them that my practice has closed. This notification may include the names and contact information of several professionals, practitioners, organizations, or other resources that individuals may wish to consider for continued consultation, personal or spiritual development, or related services.There is no individual or organization designated to succeed to or assume my practice. Any names or resources provided are offered solely as possible options for follow-up and do not constitute a specific referral, endorsement, or representation that a particular person or organization will be appropriate for any individual. I cannot guarantee the availability, services, approach, compatibility, or suitability of any person or resource identified. Each individual is responsible for determining whether a particular provider or resource is appropriate for their needs.
Disposition of Records and Client Information.
Because the services provided through this practice are consultation, educational, personal and spiritual-development, and energetic services rather than psychological diagnosis or treatment, I do not maintain psychological or psychotherapy treatment records for consultation clients. I may, however, maintain consultation-related information, including contact information, correspondence, scheduling or payment information, notes, and other information associated with the consultation relationship.
Upon my death or permanent incapacity, paper consultation records and other paper documents containing personal client information may be securely destroyed by shredding or another method reasonably designed to protect confidentiality.
Electronic client contact information and other consultation-related personal information may be retained securely for up to four (4) months following my death or the permanent closure of my practice due to incapacity. During this period, such information may be accessed and used only to the extent reasonably necessary to notify clients, respond to appropriate administrative inquiries, provide information concerning possible follow-up resources, close the practice, and complete related administrative responsibilities.
At the conclusion of this four-month period, electronic consultation records and personal client information will be securely and permanently destroyed or deleted, except for any information that must be retained for a longer period under applicable law or that is reasonably necessary for the administration of my estate or the resolution of an outstanding legal, financial, or administrative matter.
Any person assisting with the closure of my practice will be instructed to maintain the confidentiality and security of client information and to access or use such information only to the extent reasonably necessary to carry out these responsibilities.
PRIVACY NOTICE
You will find a copy of my Privacy Policy on my website. The link is located on the Home Page at the bottom of the page. By electronically signing this form, you are agreeing to the terms set forth in this policy. However, you can also, copy and paste the link below in your browser to see it. https://www.spirit-evolving.com/privacy. Should you have questions about this policy which is updated to comply with the GDPR regulations, please contact me at patrice@spirit-evolving.com. Thank you!
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.
I agree to Terms of Use and the Privacy Policy