Family and Medical Act Leave (FMLA), Short-term/Long-term Disability (STD/LTD), and Emotional Support Animal (ESA)
Here at Capacity Awakened, PLLC, we understand that mental health concerns may result in a patient needing to be absent from work, a period off from work, or other reasons that will require support from your therapist. We are here to assist you by filling out the appropriate form(s) or sending/faxing your medical records (must sign a release first). However, before assisting you with these needs, here are the following requirements that you must understand and agree to before we can assist you.
Requirements:
1. Your therapist must agree with your request.
2. Paperwork/forms are NOT filled out on or after the first appointment, but on or after the second or third session, and will be determined by the therapist.
3. You must attend weekly counseling sessions regularly.
4. Only your therapist can change the frequency of your sessions once he/she feels that weekly sessions are no longer required.
5. If an appointment is canceled (for emergency reasons ONLY) by the patient, he/she must reschedule that appointment and the new appointment must be scheduled within 7 days of the canceled appointment.
6. For canceled appointments, patients must provide proof/documentation for the emergency and the therapist will review this information to determine if the cancellation was justified. An unexcused cancellation may result in the termination of services and will be determined by the therapist.
7. Excessive cancellations or reschedules will result in the termination of services. After the third cancellation and/or rescheduling of an appointment, the patient will be terminated due to noncompliance.
8. Paperwork Fee: The fee for filling out each paperwork/form will range from $35.00 to $50.00, and the dollar amount depends on the amount of time the therapist requires to fill out the paperwork. The fee amount will be determined by your therapist. The appropriate fee must be paid before the paperwork is filled out and sent/faxed.
9. Sending Medical Records Fee: The fee for sending medical records is $25.00 each time. This fee must be paid before sending medical records.
10. Late Cancellation Fee: $60.00
11. A release of information must be filled out by the patient before sending paperwork and/or medical records.
12. Not abiding by these guidelines will result in termination of services and the appropriate personnel will be notified that the therapist will no longer support the patient’s FMLA/Disability/Related Concern claim due to non-compliance with the treatment plan.