Adventure Therapy Northwest, LLC, Based in Southern Oregon. Adventuretherapynorthwest@gmail.com

I do make it a point to work to find a rate that works, when clients are unable to pay my set rate or are experiencing a hardship. If you need assistance, let me know what fee you propose, and I will do my best to work with you.

Standard Fee Schedule

NOTE: If you have an insurance plan that covers Mental/Behavioral Health, and if I'm contracted by that plan, OR if you are utilizing an EAP service, then my rates are set by the insurance company, and are less than my Cash Rates.

My Cash Rates range from $40 to $225 for individual clinical sessions ($300 for family sessions), and $225 for 45 minute coaching sessions. Prior to your initial session, you will be charged $75 for Initial Consultation, Screening, & Intake.

Insurance and Out of Network Options

My billing goes through a 3rd party company called, Advekit. To register for Advekit, please click on the following link to visit my profile page, then select "Get Started": https://www.advekit.com/therapists/db-palmer?inn=1

5. Suspected neglect of the parties named in items #3 and # 4.

6. If a court of law issues a legitimate subpoena for information stated on the subpoena.

7. If a client is in therapy or being treated by order of a court of law, or if information is obtained for the

purpose of rendering an expert's report to an attorney.

Occasionally I may need to consult with other professionals in their areas of expertise in order to provide the best treatment for you. Information about you may be shared in this context without using your name.

If we see each other accidentally outside of the therapy office, I will not acknowledge you first. Your right to privacy and confidentiality is of the utmost importance to me, and I do not wish to jeopardize your privacy. However, if you acknowledge me first, I will be more than happy to speak briefly with you; but I will not engage in any lengthy discussions in public or outside of the therapy office.

For those that pursue Adventure Therapy options with me, we will discuss and review the clinical, privacy, and risk concerns related to this modality to determine whether or not this may be a fit for you.

About the therapist (Information for Alaska, Oregon, Utah, Louisiana, Colorado, & Washington):

1. Derick B Palmer, Alaska Online Counseling LLC & Adventure Therapy Northwest LLC - AK #PCOP713, WA LMHC LH60210091, Utah LCMHC #11640452-6004, OR LPC #C5787, LA LPC #8384, CO LPC.0017, Office Phone: 541-450-9753

2. Description of the formal professional education for the professional counselor, including the institutions attended and the degrees received from them:

Dr. Palmer attended: John Brown University (BS Recreation Management, 2002), Liberty University (MA Human Services: Marriage & Family Counseling, 2008), & American School of Professional Psychology at Argosy University (Ed.D Counseling Psychology, 2013). TeleMental Health & Digital Ethics Certificate. Certified Clinical Adventure Therapist, Certified Integrative Mental Health Professional, Certified First Responder Counselor.

3. the professional counselor's areas of specialization and the services available:

I provide professional counseling and coaching. I specialize in Clinical Adventure Therapy, Resiliency & Endurance Training, infant/early childhood, youth development concerns, family and relationship concerns, mood disorders & depression, career and transitions, work/life balance and stress, and I am well trained in many other areas. I am trained in multiple modalities, and generally practice within existential psychotherapy, cognitive-behavioral techniques, psychodynamic, and narrative therapies.

4. the professional counselor's fee schedule listed by type of service or hourly rate:

The hourly rate ranges from $225-$300 for clinical sessions, or the rate set by your insurance company, or $0 when providing EAP services. Prior to your initial session, you may be charged $50 for Initial Screening & Intake review and $25 for an Initial Consultation when paying out of pocket (cash rate) OR the rate that is set by your insurance company. If you choose to subpoena me for any reason, you will be charged for this (as noted on the informed consent/practice policies document that you will acknowledge in the intake process.

SOCIAL MEDIA AND TELECOMMUNICATION

Due to the importance of your confidentiality and the importance of minimizing dual relationships, I do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc). I believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. If you have questions about this, please bring them up when we meet and we can talk more about it.

ELECTRONIC COMMUNICATION I cannot ensure the confidentiality of any form of communication through electronic media, including text messages. If you prefer to communicate via email or text messaging for issues regarding scheduling or cancellations, I may do so. While I may try to return messages in a timely manner, I cannot guarantee immediate response and request that you do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies.

Services by electronic means, including but not limited to telephone communication, the Internet, facsimile machines, and e-mail is considered telemedicine by the State of California (and likely Alaska, Colorado, Oregon, Louisiana, and Washington, as well). Under the California Telemedicine Act of 1996, telemedicine is broadly defined as the use of information technology to deliver medical services and information from one location to another. If you and your therapist chose to use information technology for some or all of your treatment, you need to understand that: (1) You retain the option to withhold or withdraw consent at any time without affecting the right to future care or treatment or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled. (2) All existing confidentiality protections are equally applicable. (3) Your access to all medical information transmitted during a telemedicine consultation is guaranteed, and copies of this information are available for a reasonable fee. (4) Dissemination of any of your identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without your consent. (5) There are potential risks, consequences, and benefits of telemedicine. Potential benefits include, but are not limited to improved communication capabilities, providing convenient access to up-to- date information, consultations, support, reduced costs, improved quality, change in the conditions of practice, improved access to therapy, better continuity of care, and reduction of lost work time and travel costs. Effective therapy is often facilitated when the therapist gathers within a session or a series of sessions, a multitude of observations, information, and experiences about the client. Therapists may make clinical assessments, diagnosis, and interventions based not only on direct verbal or auditory communications, written reports, and third person consultations, but also from direct visual and olfactory observations, information, and experiences. When using information technology in therapy services, potential risks include, but are not limited to the therapist's inability to make visual and olfactory observations of clinically or therapeutically potentially relevant issues such as: your physical condition including deformities, apparent height and weight, body type, attractiveness relative to social and cultural norms or standards, gait and motor coordination, posture, work speed, any noteworthy mannerism or gestures, physical or medical conditions including bruises or injuries, basic grooming and hygiene including appropriateness of dress, eye contact (including any changes in the previously listed issues), sex, chronological and apparent age, ethnicity, facial and body language, and congruence of language and facial or bodily expression. Potential consequences thus include the therapist not being aware of what he or she would consider important information, that you may not recognize as significant to present verbally to the therapist.