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Meet Our Therapists

Welcome to Building Blocks Family Counseling!

Our therapists work collaboratively with their clients to help them find the best solutions for a happier and healthier life. Check out the profiles below to find the right therapist for you! 

Building Blocks Family Counseling has several interns available for low cost counseling sessions. Please call for more information. 

LPC, NCC

LPC, Counselor

MS, LMFT

Ph.D., LPC, NCC

LAMFT

PhD, LMFT, RPT-S, BC-TMH

MS, LPC, CPCS

LAMFT

LMFT

MS, LMFT, BC-TMH

Tiffany Arkwright, MS, LMFT

Focuses: Individual Counseling, Couples Counseling

[email protected]
912-349-8043 ext. 700
Locations: Pooler

 

Change! It is the one thing in life that is constant, yet certain. And we all go through changes. I can remember my transitions or changes through childhood as the youngest of a large working class, African American family–7 to be exact! I recall my changes from my childhood to teenage years, from teenager to young adulthood, and hoping to see classic fine wine adulthood! Change has definitely been a love and equally a frustration of mine that I chose and still choose to embrace for better or worse…Not disregarding the fact that it isn’t easy, in fact it can be quite messy and confusing…And without support otherwise known as “the village to raise a child folks”, life as I know it would have been…Well  unknown!

Perhaps, I would not have attended Albany State University where I received my Bachelor’s of Arts in Psychology, or my dual Bachelor’s of Science in Marketing. Perhaps I would not have obtained my Master’s of Science in Marriage and Family Therapy. Perhaps, I would not have learned the meaning of love through marriage to a wonderful husband, where worlds collided by chance…only to realize that we were always a block away from each other, attending the same elementary and high school to reconnect through a mutual best friend. Perhaps, I wouldn’t have had the opportunity to develop experience working with couples, adolescents, families…All who experience change on a quicker rate due to trauma, addiction, marital issues, depression, minority issues/multiculturalism, stress, PTSD, anxiety, anger management, obesity/weight management, self-esteem, lack of motivation, etc. Perhaps, I would not have become a Licensed Marriage and Family Therapist who thrives from collaborative solutions, challenges, and empowerment. Perhaps, I wouldn’t be able to help you with  detangling the web of confusion which we call life.

As a Licensed Marriage and Family Therapist and Clinical Fellow of the American Association of Marriage & Family Therapy,  detangling problems through promotion of healthy living physically and mentally presents an opportunity for growth, and providing skills that will support you in conquering the idea of being comfortable with being uncomfortable.  Can’t wait to conquer it with you!

I am now accepting new clients for Saturday appointments!

Terri Tyson, LPC, NCC

Focuses: Individual Counseling, Kids & Teens Counseling

[email protected]
912-349-8043 ext. 706
Locations: Pooler

 

I am a Licensed Professional Counselor who graduated from Georgia Southern University. As a true lover of education, I understand the struggle of trying to narrow down and specify just one goal. Who can choose between all the goals they have?! With all that being said … I have 2 Bachelor’s degrees (French and Spanish) and 2 Master’s Degrees (Higher Education Administration and Clinical Mental Health). I have many interests, such as a love for cats, finding that perfect cheeseburger, and experiencing many cultures through my travels. Some of my favorite places I have traveled include London, Paris, as well as living in Spain for 6 months.

For the past 4 years, I have worked in an agency setting where I work with adults who are diagnosed with Substance Abuse disorders. Through their journey, I have been able to develop an expertise in co-occurring disorders, including but not limited to depression and anxiety. I am now ready to expand my career to include children who may need assistance with mental health disorders, or maybe just feel like they have trouble fitting in. Some of the interventions I use include play therapy, dialectical behavior therapy, solution focused therapy, and EMDR.

 

Shamshad Ahmed, Ph.D., LPC, NCC

Focuses: Individual Counseling, Couples Counseling

[email protected]
912-349-8043 ext. 704
Locations: Pooler

 

I am a Licensed Professional Counselor and a National Certified Counselor. I specialize in the areas of mental health, stress management, acculturation stress, race and gender, self-esteem, and family and relationship issues. I believe that relationships make up the core of our lives. They can be fulfilling, yet also challenging at times. When we get stuck in our relationships, my role is to assist you in determining where you are in your relationship and what choices are available for you. I work on a range of methods, including meditation, person centered, intuitive guidance, mindfulness, journaling, visualization, and cognitive behavior therapy.I believe in collaborating with other professionals to help clients achieve fulfilling relationships and optimal health. I work with individuals and groups.

 

Savanah Kite, LAMFT

Focuses: Couples Counseling, Kids & Teens Counseling, Online Counseling

[email protected]
912-349-8043 ext. 709
Locations: Online

 

My name is Savanah and I am a Licensed Associate Marriage and Family Therapist. You read that correctly, my name is spelled with only one N and my parents told me it was because we couldn’t afford both. I grew up in a family that had a lot of the right ingredients (like warmth, care, and humor) but didn’t have some of the tools that would have made home life a whole lot easier for us all. So, I became a Marriage and Family Therapist because I believe families are where we can experience a lot of pain and frustration, but also where we can experience tremendous healing. All families are a cross-cultural experience and it often requires curiosity and patience to get the most out of these special relationships. On an individual level, I know the relief of breaking free from behaviors and thoughts that keep us in the exhausting cycle of pain and confusion.

I work from a humanistic framework that suggests we all have within us what we need to be the best versions of ourselves, but that low self-worth can cloud that. I’m known for my humor, warmth, and knack for finding and revealing the strengths that we all possess.

Therapy doesn’t have to be stuffy. I enjoy using play therapy techniques, artistic mediums like drawing and music, and games as a way to communicate and heal. The only game I’m not interested in playing is the blame game. We will discover the solutions to our issues much more quickly if we focus on interaction patterns, communication skills, and our own desires to give and receive understanding and support to and from those we love.

Some populations that I’m most excited to work with are families, couples, children, teens, the LGBTQIA community, and people of color/culture.

A song that reminds me of doing therapy is “I’ll Be Your Mirror,” by The Velvet Underground. I’m excited to get to know you and empower you to dig deep, find your courage, and tackle the uncomfortable and sticky parts of life.

I’m currently accepting telehealth appointments and can be reached at 912. 349. 8043 ext 709 or by email [email protected]

Sarah Padgett, LMFT

Focuses: Couples Counseling, Kids & Teens Counseling

[email protected]
912-349-8043 ext. 701
Locations: Rincon

 

Hey y’all! I’m Sarah Padgett, and I’m a licensed Marriage and Family Therapist. After finding the field of Marriage and Family Therapy, I knew there was no other career for me. I’ve always been passionate about helping children and families, and now I’m granted opportunities to on a daily basis. Truly living the dream for me! I obtained my Bachelor’s Degree from the University of Georgia and went on to pursue my Master’s at East Carolina University. Now, I have the joy of working with families to create long-lasting change. I especially enjoy work with families with children & adolescents struggling with behavioral and social issues such as: depressive symptoms, anxiety symptoms, peer relationships, life transitions, difficulty with emotional expression, defiance, and anger outbursts. It is important for me to not only work with the children involved, but the whole family unit, to help create the desired home environment for your family through a strengths-based, solution-focused therapeutic approach. I look forward to working with your family soon!

Rachel Huffman, LAMFT

Focuses: Couples Counseling, Kids & Teens Counseling, Online Counseling

[email protected]
912-349-8043 ext. 708
Locations: Pooler, Online

 

I am a licensed associate marriage and family therapist. I graduated from Georgia Southern University with a Bachelor’s degree in Psychology and a minor in child and family development. I continued my education and graduated from Northcentral University with a Master’s in marriage and family therapy. I knew from a young age that my passion was helping people. In my experience I have worked with individuals, couples, families, children, and teens with a wide range of concerns. Together we have overcome depression, anxiety, infidelity, trust, commitment, communicating/understanding, past resentment/regrets, reunification/reconnecting, reconciling, emotional regulation, impulsivity, behavioral concerns, ADHD, sexual abuse, substance abuse, trauma, suicidality, and much more.

Some methods that I utilize include: Gottman’s couples therapy, play therapy, DBT, CBT, and solution focused therapy. I also believe that your experiences and environment help to shape who you are and what you believe. I help clients look at where they have been, where they are, and help them figure out where they are going.

I am accepting new clients Monday-Sunday and am located out of our Pooler location. Can’t make it to the office, ask me about telehealth/online appointments. Have a high deductible, ask me about my reduced rates. I look forward to helping you in any way I can.

LaManica Vinson, MS,LPC, CPCS

Focuses: Individual Counseling, Couples Counseling, Kids & Teens Counseling

[email protected]
912-349-8043 ext. 712
Locations: Rincon

 

I Absolutely Love what I Do! I provide individual and family therapy for children, tweens, adolescents, families, and adult individuals. I specialize in working with children who have behavioral issues, mood disorders, depression, low self-esteem, struggling with managing their emotions, impulsivity, behavioral concerns, school difficulties, anxiety, ADHD, and trauma.

I am a Licensed Professional Counselor in the State of Georgia as well as a Certified Professional Counseling Supervisor. I received my Bachelors Degree in Psychology from the University of West Florida and my Masters of Science Degree in Counseling and Psychology. I am also in the process of becoming a Registered Play Therapist. I have been working in the clinical mental health field for over 13 years.

Kathryn Klock-Powell, PhD, LMFT, RPT-S, BC-TMH

Focuses: Kids & Teens Counseling, Online Counseling

[email protected]
912-349-8043 ext. 703
Locations: Rincon

 

I am a licensed marriage and family therapist, registered play therapist, and an approved supervisor for AAMFT and APT. I have over 20 years of clinical experience and specializes in children with trauma, high conflict divorce, and behavioral issues. My areas of expertise includes domestic violence, sexual abuse, trauma, families with children on the autism spectrum, and same sex relationships. I also utilize play therapy techniques and experiential activities in my clinical work. I am currently serving on the Georgia Composite Board for Licensed Professional Counselors, Marriage and Family Therapists, and Social Workers.

Julia Jerome, LPC, Counselor

Focuses: Individual Counseling, Kids & Teens Counseling, Online Counseling

[email protected]
912-349-8043 ext. 705
Locations: Pooler

 

If there is anything I know well, it is how to start over. I first graduated with a Bachelor’s in History, and then a Master’s in Public Administration with the hopes of working in museums. Although, I loved working with the artifacts and talking with people on their tours, I realized my passion involved working with people and having meaningful interactions. At this point, I looked into a career where I would have more of these interactions, and Georgia Southern offered me an opportunity to work with young adults. After a few years, I realized that I still wasn’t in the right career, because I still was not able to obtain the fulfillment I was longing for. I once again, looked to school and followed my passion of helping people.

In 2014, I graduated from Georgia Southern University with a Master’s in Education in Clinical Mental Health and I am now pursuing my certification in play therapy.

I am a licensed professional counselor who specializes in a play therapy, person-centered approach that benefits all ages. For the past few years, I have been working in an agency setting, which has allowed me to hone my skills in assisting clients to develop their coping skills and set goals in the areas of mental health particularly anxiety and depression, stress management, building healthy relationships, while also building self-esteem and defining who it is you want to be.

Ashley Moore, MS, LMFT, BC-TMH

Focuses: Individual Counseling, Couples Counseling, Online Counseling

[email protected]
912-349-8043 ext. 702
Locations: Pooler

 

I am a licensed marriage and family therapist specializing in relationship issues in the Pooler, GA area. I received my Bachelor’s Degree in Psychology with a minor in Sociology from Valdosta State University in 2008. During this time, I discovered my passion was working with couples and families in a therapeutic setting. This led me to complete my Master’s Degree in Marriage and Family Therapy from Valdosta State University in 2010.

After school, I moved back home to Savannah and married my high school sweetheart in 2012. “Practicing what I preach” in my relationship can be hard but it gives me a deeper understanding and appreciation of marriage. In 2016, I had my first child and began this great adventure called parenthood. Finding a balance between work life, wife life, and mom life has been an interesting journey for me. I try to use my education and life experiences, to meet my clients where they are at and help them get to where they want to be.

As a Marriage and Family Therapist, my goal is to help you explore what keeps you (and/or your partner/family) “stuck” and work toward creating new cycles of interaction. I’ve helped lots of couples and families find healthy solutions for a deeper connection and more satisfying relationships.

I am currently a level one Gottman trained couples therapist. I specialize in working with couples dealing with premarital issues, infidelity, communication issues, parenting, etc. I also work with individuals struggling with relationship issues.

 

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COVID-19 Announcement

Building Blocks Family Counseling has been monitoring the current COVID-19 pandemic. The safety of our clients is our number one priority. Because of the contagious nature of this virus, we are taking all precautions possible.

Please click here to read our important announcement regarding appointments.

Step 1 of 5 - Professional Disclosure Statement

  • Informed Consent

    Welcome to Building Blocks Family Counseling where we provide solutions to build healthy families. We are very pleased that you selected our practice for your care, and we sincerely look forward to assisting you. This document is designed to inform you about what you can expect from therapy with your therapist, policies regarding confidentiality and emergencies, and several other details regarding your treatment here. Although providing this document is part of an ethical obligation to our profession, more importantly, it is part of our commitment to you to keep you fully informed of every part of your therapeutic experience. Please know that your relationship with your therapist is a collaborative one, and they welcome any questions, comments, or suggestions regarding your course of care at any time.
  • What is Therapy?

    Our therapists are required to have graduate training (a Master's or Doctoral degree) in their professional field and at least two years of clinical experience post master’s before they are eligible to obtain full independent licensure. Additionally, they are also required to pass the national board exam before obtaining their license. Therapists are mental health professionals trained in psychotherapy, as well as licensed to diagnose and treat mental and emotional disorders. We are required by law to uphold the rules and regulations put upon us by the State of Georgia. Your therapist's scope of practice and Georgia law does not allow your therapist to provide custody evaluations of any type. Your therapist also does not provide disability evaluations or recommendations as well as fit for duty or work recommendations. Your therapist does not provide medication or prescription recommendation nor legal advice, as these activities do not fall within their scope of practice. These will be left up to the appropriate provider and if need be; your therapist can provide recommendations to these professionals.
  • The Process of Therapy; Risks and Benefits

    As with any treatment, there are some risks as well as many benefits with therapy. You should think about both the benefits and risks when making any treatment decisions. For example, in therapy, there is a risk that clients will, for a time, have uncomfortable levels of sadness, guilt, anxiety, anger, frustration, loneliness, helplessness, or other negative feelings. Clients may recall unpleasant memories. These feelings or memories may bother a client at work or in school. In addition, some people in your community may mistakenly view anyone in therapy as weak, or perhaps as seriously disturbed. Also, clients in therapy may have problems with people important to them. Family secrets may be told. Therapy may disrupt a marital relationship. Sometimes, too, a client’s problems may temporarily worsen after the beginning of treatment. Most of these risks are to be expected when people are making important changes in their lives. Finally, even with our best efforts, there is a risk that therapy may not work out well for you.

    While you consider these risks, you should also know that the benefits of therapy have been shown by scientists in hundreds of well-designed research studies. People who are depressed may find their mood lifting. Others may no longer feel afraid, angry, or anxious. In therapy, people have a chance to talk things out fully until their feelings are relieved or the problems are solved. Clients’ relationships and coping skills may improve greatly. They may get more satisfaction out of social and family relationships. Their personal goals and values may become clearer. They may grow in many directions—as persons, in their close relationships, in their work or schooling, and in the ability to enjoy their lives. Your therapist does not take on clients they do not think they can help. Therefore, your therapist will enter your relationship with optimism about your progress.

  • What to Expect from Our Relationship

    As a professional, your therapist use their knowledge and skills to help you. This includes following the standards of the Georgia Composite Board of Professional Counselors, Marriage and Family Therapists and Social Workers and the applicable code of ethics. In your best interests, these ethical codes put limits on the relationship between a therapist and a client, and your therapist will abide by these. Let me explain these limits, so you will not think they are personal responses to you. First, I am licensed and trained to practice psychotherapy—not law, medicine, finance, or any other profession. I am not able to give you good advice from these other professional viewpoints. Second, state laws and our code of ethics require me to keep what you tell me confidential (that is, private). You can trust me not to tell anyone else what you tell me, except in certain limited situations. (Explained in the HIPAA Notice Privacy Practices.) Here I want to explain that I try not to reveal who my clients are. This is part of my effort to maintain your privacy. If we meet on the street or socially, I may not say hello or talk to you very much. My behavior will not be a personal reaction to you, but a way to maintain the confidentiality of our relationship. Third, in your best interest, and following the code of ethics, I can only be your therapist. I cannot have any other role in your life. I cannot, now or ever, be a close friend or socialize with any of my clients. I cannot be a therapist to someone who is already a friend. I can never have a sexual or romantic relationship with any client during, or after, the course of therapy. I cannot have a business relationship with any of my clients, other than the therapy relationship.
  • About Confidentiality

    I will treat with great care all the information you share with me. It is your legal right that our sessions and my records about you be kept private. That is why I ask you to sign a “release-of-records” form before I can talk about you or send my records about you to anyone else. In general, I will tell no one what you tell me. I will not even reveal that you are receiving treatment from me. In all but a few rare situations, your confidentiality (that is, your privacy) is protected by state law and by the rules of my profession. The details are outlined on the HIPAA notice of Privacy Practices that you have received.

    There are two situations in which I might talk about part of your case with another therapist. I ask now for your understanding and agreement to let me do so in these two situations. First, when I am away from the office for a few days, I have a trusted fellow therapist “cover” for me. This therapist will be available to you in emergencies. Of course, this therapist is bound by the same laws and rules as I am to protect your confidentiality. Second, I sometimes consult other therapists or other professionals about my clients. This helps me in giving high-quality treatment. These persons are also required to keep your information private.

    Your name will never be given to them, and they will be told only as much as they need to know to understand your situation. If I must discontinue our relationship because of illness, disability, or other presently unforeseen circumstances, I ask you to agree to my transferring your records to another therapist who will assure their confidentiality, preservation, and appropriate access. There is an exception to confidentiality because of the family nature of the therapy I provide. I do not keep family secrets from family members as I think that secrets are often at the root of family problems. I also will not go behind your back. Instead, if you reveal something to me that I feel would be something important to share with your family members I will talk to you about it and encourage you to disclose that information yourself, or even help you in that disclosure.

  • Consultations

    If you could benefit from a treatment I cannot provide, I will help you to get it. You have a right to ask me about such other treatments, their risks, and their benefits. Based on what I learn about your problems, I may recommend a medical exam or use of medication. If I do this, I will fully discuss my reasons with you, so that you can decide what is best. If you are treated by another professional, I will coordinate my services with them and with your own medical doctor.

    If for some reason treatment is not going well, I might suggest you see another therapist or another professional in addition to me. As a responsible person and ethical therapist, I cannot continue to treat you if my treatment is not working for you. If you wish for another professional’s opinion at any time, or wish to talk with another therapist, I will help you find a qualified person and will provide him or her with the information needed.

  • Technology Statement

    In our ever-changing technological society, there are several ways we could potentially communicate and/or follow each other electronically. It is of utmost importance to us that we maintain your confidentiality, respect your boundaries, and ascertain that your relationship with your therapist remains therapeutic and professional. Therefore, we’ve developed the following policies:

    Video Monitoring and Recording: There may come a point in treatment when your therapist may request to video record/film sessions. Prior to filming, your therapist will discuss the terms and agreements as well as having a separate consent form signed. The client always has the option to not give consent.

    Cell Phones: It is important for you to know that cell phones may not be completely secure and confidential. However, we realize that most people have and utilize a cell phone. Your therapist may also use a cell phone to contact you. If this is a problem, please feel free to discuss this with her. Out of respect for yourself and the therapeutic process, your therapist does ask that all clients silence their phones and do their best not to respond to messages or take calls during therapy.

    Text Messaging and Email: Both text messaging and emailing are not secure means of communication and may compromise your confidentiality. However, we realize that many people prefer to text and/or email because it is a quick way to convey information. Please note that your therapist does not accept or send texts as a way of communication with the exception to remind of appointments. Appointment reminders via text and email are sent from an automated system that you will not be able to respond to. Email will not be used for crisis situations or as a substitute for therapy. We ask that email only be used for brief matters of communications that can allow for a 24-48 hour response time. You also need to know that we are required to keep a copy of all emails and other electronic communications as part of your clinical record. If you find the need to communicate frequently with your therapist between sessions, it may be that you need to schedule more frequent visits. You are encouraged to protect your own confidentiality by controlling access to your communications with your therapist such as by using passwords only known by you, controlling access to your computer, etc. Please discuss with your therapist the preferred way for communicating outside of session.

    Facebook, LinkedIn, Instagram, Pinterest Etc: It is your therapist's policy not to accept requests from any current or former clients on social networking sites such as Facebook, LinkedIn, Instagram, Pinterest, etc. because it may compromise your confidentiality. You may “like” the Building Blocks Family Counseling Facebook page as this is a community page where upcoming events and helpful information are shared. We also encourage all clients to sign up to receive the Building Blocks weekly newsletter which is filled with blog posts, helpful tips, and upcoming events.

    In summary, technology is constantly changing, and there are implications to all of the above that your therapist may not realize at this time. Please feel free to ask questions, and know that she is open to any feelings or thoughts you have about these and other modalities of communication.
  • About Our Appointments

    The very first time I meet with you, we will need to give each other much basic information. We will usually meet for a session once a week, then less often. We can schedule meetings for both your and my convenience. I will tell you at least a month in advance of my vacations or any other times we cannot meet.

    I will reserve a regular appointment time for you into the foreseeable future. I also do this for my other patients. Therefore, I am rarely able to fill a cancelled session unless I have several days’ notice.

    You will be charged the full fee for sessions cancelled with less than 24 hours’ notice, for other than the most serious reasons. Insurance will not cover this charge.
  • Fees, Payments, and Billing

    Please refer to the pricing sheet provided for you.

    I accept debit and credit cards, health savings account, cash, or check. Those with insurance coverage are expected to pay the co-payment or co-insurance at the time of service. If your insurance coverage is rejected, then you will be responsible for the full fee. You should call your insurance company to verify benefits, determine co-pay amounts, and get information on deductibles, prior authorization or the need for a doctor’s referral.

    Payment should be made when services are rendered. If you think you may have trouble paying your bills on time, please discuss this with me. If you get behind more than the cost of two sessions, I will notify you in writing. If it then remains unpaid, I must stop therapy with you. Fees that continue unpaid after this will be turned over to small-claims court or a collection service.

    If there is any problem with my charges, my billing, your insurance, or any other money-related point, please bring it to my attention. I will do the same with you. Such problems can interfere greatly with our work. They must be worked out openly and quickly.

  • If You Need to Contact Me

    cannot promise that I will be available at all times. I do not take phone calls when I am with a client. You can always leave a message on my confidential voicemail, and I will return your call as soon as I can. Generally, I will return messages daily except on weekends and holidays.

    If you have a behavioral or emotional crisis and cannot reach me, you or your family members should call the Georgia Crisis and Access Line at (800) 715-4225, or go to the nearest hospital emergency room (or dial 911).

  • Statement of Principles and Complaint Procedures

    It is my intention to fully abide by all the rules of the Georgia Composite Board of Professional Counselors, Marriage and Family Therapist and Social Workers. Problems can arise in our relationship, just as in any other relationship. If you are not satisfied with any area of our work, please raise your concerns with me at once. I will make every effort to hear any complaints you have and to seek solutions to them. If you feel that I, or any other therapist, has treated you unfairly or has even broken a professional rule, please tell me. You can also contact the Georgia Secretary of State. A representative can help clarify your concerns or tell you how to file a complaint.

    In my practice as a therapist, I do not discriminate against clients because of any of these factors: age, sex, marital/family status, race, color, religious beliefs, ethnic origin, place of residence, veteran status, physical disability, health status, sexual orientation, or criminal record unrelated to present dangerousness. I will always take steps to advance and support the values of equal opportunity, human dignity, and racial/ethnic/cultural diversity. If you believe you have been discriminated against, please bring this matter to my attention immediately.

  • Our Agreement

    I, the client (or his or her parent or guardian), understand I have the right not to sign this form. My signature below indicates that I have read and discussed this agreement; it does not indicate that I am waiving any of my rights. I understand I can choose to discuss my concerns with you, the therapist, before I start (or the client starts) formal therapy. I also understand that any of the points mentioned above can be discussed and may be open to change. If at any time during the treatment I have questions about any of the subjects discussed in this handout, I can talk with you about them, and you will do your best to answer them.

    I understand that after therapy begins I have the right to withdraw my consent to therapy at any time, for any reason. However, I will make every effort to discuss my concerns about my progress with you before ending therapy with you.

    I understand that no specific promises have been made to me by this therapist about the results of treatment, the effectiveness of the procedures used by this therapist, or the number of sessions necessary for therapy to be effective.

    I have read, or have had read to me, the issues and points in this handout. I have discussed those points I did not understand, and have had my questions, if any, fully answered. I agree to act according to the points covered in this brochure. I hereby agree to enter into therapy with this therapist (or to have the client enter therapy), and to cooperate fully and to the best of my ability, as shown by my signature here. My signature below also indicates that I have been given a copy of the HIPAA Notice of Privacy Practices. My signature authorizes the release of information necessary to process health insurance claims and authorizes the payment of health benefits directly to the provider (if applicable).

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