Welcome, it takes courage to reach out for support. These forms contain information about your therapist Naftoli Sobel who is doing business as Seen and Heard Therapy. This form must be completed by you and provided to your therapist. Please take time to carefully review the following.

Confidentiality

Therapy is best experienced in an atmosphere of trust. Thus, all therapy services are strictly confidential and may not be revealed to anyone without your written permission**. There are exceptions to confidentiality where disclosure is required by law (see below).** There may be occasions where your therapist may consult with adjunct therapists in order to discuss aspects of your sessions to best support your process. When doing so, please understand that your name will not be used and your therapist will change significant identifying details in order to protect your confidentiality.

Confidentiality and Written Consent

Should you request that your therapist speak with another professional or person (i.e. doctors, former therapists, teachers, family, friends or anyone else outside the therapy room), you must first provide your signed written consent in order to do so and only after your therapist determines if this is in the best interest in supporting your therapeutic process and progress.

Under NJ law, minors age 14 and older must provide written consent, along with that of their parent or guardian, for any release of records relating to their therapy.

Confidential Electronic Data Storage and Email Transmission

Your confidentiality as a client is of upmost importance. To support and secure your clinical information, I utilize the following data storage and email services Halaxy and gmail.

Please understand that while every measure will be taken to protect your information and identity, there is not a 100% fail proof way of ensuring complete confidentiality when communicating via the Internet or email. If you choose to communicate via email, phone, text, or a therapy platform, possibilities for compromised confidentially to be aware of include: human error on your side or the side of your therapist, hacking, theft, monitoring by Gmail or Halaxy.

I understand Seen and Heard Therapy will do all they can to protect my confidentiality and

records. I understand that complete confidentiality can never be 100% guaranteed when using the Internet, email, therapy platforms, or texting. I give permission to my therapist to communicate with me or respond to me via email platform, phone,Halaxy , when needed, and understand the risks involved.

Legal Exceptions to Confidentiality

Seen and Heard Therapy takes your confidentiality very seriously. Your information is confidential, with the exception of information relating to child abuse, or suspected child abuse, child pornography, elder abuse, dependent adult abuse, or intent to harm self or others, or unless mandated by a court of law. Legally, therapists are mandated reporters of abuse or intent to harm self or another person. If you are suicidal or homicidal, your therapist will take all reasonable steps to prevent harm to you or another. Legal exceptions to confidentiality are in place to protect your safety and the safety of others. This includes: when there is a reasonable suspicion of child abuse (physical, sexual, emotional, neglect), or adult dependent care

abuse, elder abuse/neglect; and where a client threatens to harm or kill other(s) (homicide), or threatens to damage another person’s property. If I believe that you are at risk of harming yourself or identifiable third parties, I am obligated by New Jersey

law to notify law enforcement, among other steps. Kindly review NJSA 2A:62A-16 which sets forth my obligations under such circumstances. Additionally*,* if a court issues an order to release records (for example a divorce hearing or custody hearing), your therapist must abide by the court order and may be compelled by court order to testify under oath and thus must answer all questions honestly.

Mandated Reporting of Incidents Involving Minors

Under NJ law, specifically NJSA 9:6-8.10, every person is a mandated reporter of child abuse and neglect. These terms are defined at NJSA NJSA 9:6-1.

Suicide Policy

If I believe that you are at risk of harming yourself, I am obligated by New Jersey law to notify law enforcement, among other steps. Kindly review NJSA 2A:62A-16 which sets forth my obligations under such circumstances.

Appointments/Cancellations

The cancellation policy is 24 hours. If you cancel your session at least 24 hours prior to your scheduled session, you will not be charged. If you are trying to reach your therapist on the same day of your session, please contact your therapist immediately. Naftoli Sobel phone number is: 908721799

Please note that cell phones cannot be guaranteed as confidential. I make every effort to return calls and emails within 24 hours. It is understandable that occasionally emergency circumstances beyond your control may arise which would prevent you from keeping your appointment. If your therapist is unable to attend your therapy session (outside of scheduled vacations) due to an unexpected emergency or illness, every attempt will be made to contact you 24 hours in advance on the phone numbers and/or email you have provided.

NOTE: If you are sick or experiencing any symptoms of illness (cough, cold, flu, fever, rash, pink eye, intestinal ailments, or other contagions), and you meet with your therapist in the office, the policy is that you conduct your session via the phone/video. If your therapist is ill, the same consideration will be extended. If you arrive to your session ill, you will be asked to leave the office so not to expose your therapist or other clients, and your full fee will be charged.

Client Cancellation Procedures and Fees

Short-Notice Cancellation: I have a 24-hour cancellation. Appointment cancellations made less than 24 hours before the scheduled appointment will be charged 75$ for the session.

Ongoing Cancellations or Multiple No-Shows: It is understandable that occasionally an appointment will be canceled or missed due to illness or emergency. However, your regular session day/time has been reserved for you. My current client schedule and wait list does not allow for flexibility with respect to continual cancellations, rescheduled appointments, or no shows.

If you find that your schedule is no longer able to accommodate the session time reserved for you, please discuss this with your therapist. Your therapist will do their very best to find an alternative day and time so that you can continue your work. However, please note that should ongoing cancellations, frequent reschedules (even those within the same

week), missed appointments, late payments/nonpayment become an issue, your therapist will discuss this with you. If after discussing other options with you your attendance has not changed, your therapist will open up your reserved time to the waitlist and add you to the waitlist. If you prefer not to be placed on the waitlist, then you will be provided with therapy referrals.

Appointments/Cancellations

Client Cancellation Procedures and Fees

Short-Notice Cancellation: I have a 24-hour cancellation. Appointment cancellations made less than 24 hours before the scheduled appointment will be charged 75$ for the session.

Your signature below indicates your agreement to the boundaries around client contact during your therapist’s time away.

Naftoli Sobel Psychotherapist

Info

Qualifications and Experience

Education

Certifications