.Copyright © 2018
Michael T. Hurlock Ph.D. LMFT LPC NCC
All rights reserved.
Michael T. Hurlock Ph.D. LMFT LPC NCC
9 Dunham Pond Road, Storrs, CT 06268
Phone: (860) 477-0497 Fax: (860) 477-0532
mhurlockphd@charter.net
Practice Policies
Our first and possibly second session involve an evaluation of
your needs.  By the end of the evaluation, I will be able to offer
you some initial impressions of what our work will include and
an initial treatment plan.  Since therapy involves a commitment
of time, money, and energy, you should be very careful about
the therapist you select.  If you have any questions about my
procedures and qualifications, please feel free to discuss them
with me.
The following Sections on this page offer a brief outline for how I
run my private practice:

-- Downloadable Intake Forms          -- Professional Fees/Billing
-- Appointments                               -- Professional Records
-- Contacting Me                              -- Confidentiality
Downloadable Intake Forms
Please download, print, and sign these documents prior to our first session. If
you cannot download these documents or have questions regarding these
documents please contact me prior to our first session.  
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Client Bill of Rights
This contains and explains your rights as a client regarding privacy,
confidentiality, requesting information, uses and disclosures of your
protected health information, and your responsibilities as a client.
 

Patient Intake Information
This provides me with background information about you and your
needs.  It will be kept on file so that if necessary I can contact you,
your primary care physician, and/or your insurance company.

Clinical Services and Counseling Fee Agreement
This contains and explains each clinical service, including therapy
sessions, missed appointments, court evaluations, and a formula
for my sliding scale fee.

Consent Agreement
This contains and explains different items that need your consent
before we begin therapy sessions together.  Consent means that
you have read each item and that you understand, are aware,
authorize, and/or are responsible for each item.
I normally schedule one 45 minute session per week at a mutually agreed upon time.  
The sessions we schedule are reserved for you.  I will charge you for appointments not
canceled at least 24 hours in advance unless you have an emergency.  I usually take a
couple of weeks off throughout the year for vacation and trainings.  I will let you know of
my planned time out of the office as soon as I am able.  To schedule an appointment
call my office number at (860) 477-0497 or send me an email at
mhurlockphd@charter.net
I am often not immediately available by telephone.  While I am usually in my office
between 9 AM and 7 PM, I don't answer the phone when I am with a client.  When I am
unavailable, my telephone is answered by a confidential voicemail service, which I
monitor frequently.  I will make every effort to return your call on the same day you
make it, with the exception of weekends and holidays.  If you cannot reach me and feel
that you cannot wait for me to return your call, you should call your primary care
physician or the emergency room at the nearest hospital, and ask for the mental health
person on-call.
If you have health insurance, it will probably provide some coverage for outpatient
mental health treatment.  I will assist you in facilitating your use of the benefits to which
you are entitled, and I have an independent billing service to send claims to your
insurance company.  Most insurance agreements require you to authorize me to
provide them with a clinical diagnosis and with dates of your appointments.  This
information will become part of your insurance company's files.  If you request it, I will
provide you with a copy of anything I send to your insurance company.

My session fees are listed on the services page, as well as on the Contracted Fee
Agreement that I ask you to download, print, and sign.  I ask that you pay your co-pay
or agreed-upon fee at each session, either by check or cash.  A statement will be sent
to you every month with a balance and the payments you have made, which can be
used as a receipt.
Both the law and standards of my profession require that I keep appropriate treatment
records.  You are entitled to review your records whenever you wish.  If you wish to
review your records, I recommend that you review them in my presence so that we can
discuss the contents.
The confidentiality of all communications between a client and a therapist is protected,
and in general, I can release information about our work to others only with your written
permission.  However, there are several exceptions to this general rule.

In most judicial proceedings you have the right to prevent me from providing any
information about your treatment.  However, in some circumstances, such as child
custody proceedings and proceedings in which your emotional condition is a
determining element, a judge may require my testimony if they determine that resolution
of the issues requires it.

There are some situations in which I am legally required to take action and often
require that I release information.  For example, I must notify the appropriate people if I
believe a child is being abused (or is at risk for abuse), if a client is threatening bodily
harm to another person, or if a client threatens bodily harm to themselves.  These
situations have arisen rarely in my practice.  However, should such a situation occur, I
will make every effort to discuss it with you before taking any action.

I may occasionally find it helpful to consult about a client with other professionals.  In
these consultations, I make every effort to avoid revealing the identity of my client.  The
consultant is also legally bound to keep this information confidential.  Unless you
object, I will not tell you these consultations unless I feel is important for our work
together.
Michael T. Hurlock, Ph.D. LMFT LPC NCC
Family Therapist

9 Dunham Pond Road
Storrs, Connecticut 06268
phone (860) 477-0497
fax (860) 477-0532
mhurlockphd@charter.net

"Listen or Your Tongue Will Make You Deaf"
-- Native American proverb
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