Welcome! I am honored to be able to provide you, your family, and our community with individual, couples, and family counseling. I provide therapy with professional quality, evidence-based psychotherapy to support individual, family, and community wellness. I am dedicated to practicing with the utmost professionalism, integrity, confidentiality/privacy, respect, and cultural sensitivity in order to create a positive and collaborative therapeutic relationship. I guide clients in the exploration and achievement of their unique, personal needs and goals. My ultimate goal is to help my clients enhance their overall sense of well-being and life satisfaction.

I am currently a Licensed Marriage and Family Therapy (LMFT) in North Carolina (#1991) and Georgia (MFT001816). I believe in the importance of a collaborative approach to therapy. I recognize everyone's diverse and unique backgrounds; therefore I work closely with my clients to understand their needs and goals, which is the basis of treatment planning. My theoretical orientation is rooted in family systems theory. I recognize, as individuals we are connected and influenced by those around us and the environments we share. I also believe we all have strengths that can be used to help address life's difficult times. My role as a therapist is to help bring out those strengths and tap into our capacity and will to overcome.

Please review the following information and provide the requested signatures to confirm you have received, understand, and are in agreement with my policies, procedures, roles, and responsibilities. Please feel free to ask any questions or present any concerns you may have, and I will gladly address any of these matters with you.

Office Hours and Appointments Acknowledgement and Agreement:

Appointments are available upon request. You can schedule an appointment by calling 704-621-7891 or by emailing me at drfaith@drfaithtroupe.com. You may also make an appointment at the end of your therapy sessions or set up a weekly "standing" appointment.

Therapy sessions typically run a clinical hour, which is 50-55 minutes. I am committed to beginning and ending sessions on-time to respect the schedules and time allotted for every client I serve; therefore, it is important that you understand that lost time is not made up at the end of an appointment if you arrive late. On the rare occasion that I may be running behind schedule, you will be guaranteed to be seen for a minimum of 50 minutes.

If you need to contact me between sessions, the best way to do so is by phone at 704-621-7891. Direct email at drfaith@drfaithtroupe.com is second best for quick, administrative issues such as changing appointment times. If I am in session and unable to take your call, please leave a message with your name, phone number (speak your # slowly) and a brief reason for your call. Unfortunately, I am not available 24/7 so if you are in an emergency and need immediate assistance, call 911 or go to the nearest emergency room. Additionally, if you are experiencing a mental health, substance abuse, or developmental disability crisis, you may call your local crisis line.

My business hours are Monday-Thursday from 10am to 7pm, so if you call and leave a voicemail during those hours, I will try to respond to you within 24 business hours. Please remember that due to the nature of my business, each session is an hour allotted for you as my client. I do not answer calls, texts, or emails during sessions; this courtesy unfortunately limits my ability to communicate quickly outside of session.

Please limit communication via text or email to scheduling only as these are not secure or confidential means of communication. Text messages and email are not appropriate means to communicate sensitive and therapeutic information. Email and text messages should only be used to arrange or modify appointments. Please do not email me content related to your therapy sessions, as these forms of communication are not completely secure or confidential. You should also know that any text messages or emails I receive from you and any responses that I send to you become a part of your legal medical record.

Social Media Policy

This section outlines my office policies related to use of Social Media. Please read it to understand how I conduct myself on the Internet as a mental health professional and how you can expect me to respond to various interactions that may occur between us on the Internet. If you have any questions about our communication outside of session, I encourage you to bring them with me directly. As new technology develops and the Internet changes, there may be times when I need to update this policy.

I do not accept friend or contact requests from current or former clients on any social networking site (Facebook, Linked In, 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.

Business Review Sites

You may find my practice on sites such as Yelp, Healthgrades, Yahoo Local, Bing, etc. Some of these sites include forums in which users rate their providers and add reviews. Many of these sites comb search engines for business listings and automatically add listings that are not approved by me personally. If you should find my listing on any of these sites, please know that my listing is NOT a request for a testimonial, rating, or endorsement from you as my client. Nor is there a guarantee that the information listed is accurate and correct.

The time you schedule for therapy is reserved specifically for you. If you fail to come to your appointment, the hour goes unused. Please notify me as soon as you realize you cannot keep your scheduled appointment. There are no charges for cancelled appointments provided that you give 24 hours notice; however, a fee of $100 will be applied to your account for no-shows and cancellations made with less than 24 hours notice. This additional fee is not reimbursable by insurance and will be due prior to the start of the next scheduled session.

If you miss a session and owe a no show or late cancellation fee, your credit card on file will be charged. Please provide the requested credit card information on your intake paperwork, and initial indicating that you understand that your card will be charged for late cancellations.

The full fee is due at the beginning of each session in order for therapy services to be provided. Cash, personal checks, credit cards, and debit cards are all accepted forms of payment, and I will gladly provide you with a receipt for each session if requested. If you anticipate difficulty with payment, please discuss your concerns with me. I strive to provide services to anyone wanting help and will do what I can to accommodate your financial circumstances, even if referring you to an alternate provider may be more feasible for you.

Please note that a $30 charge will be applied to your account for any returned checks. These fees, along with any outstanding balances, must be paid prior to your next session. Should two consecutive sessions remain unpaid, the full balance would need to be settled within one week from the date of non-payment of service in order to be able to schedule further appointments. Additionally, after two declined payments, cash or money order will be the only accepted form of payment to settle the balance and for all future appointments.

Provider Out of Pocket Fees:
Individual Therapy: First session for full 60-minute assessment is $140. Subsequent 60-minute sessions are $120.

Under Section 2799B-6 of the Public Health Service Act, you have the right to receive a "Good Faith Estimate" explaining how much your medical care will cost. Under the law, health care providers need to give clients who don't have insurance or who are not using insurance an estimate of the bill for medical items and services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees. Please refer to your Good Faith Estimate for a detailed list of expected charges.

Your therapy is confidential and will not be disclosed to anyone else without your written consent. However, there are at least four exceptions to this rule:

1. If information is conveyed to me that indicate you are dangerous to yourself or others, I am required by law to take action, to assure that no one is harmed.

2. North Carolina State law requires therapists report to the Department of Social Services any abuse or neglect or suspected abuse or neglect of a child or dependent adult. If this is a topic of concern to me, I will inform you prior to contacting authorities.

3. If you plan to use your receipt for reimbursement by your insurance company, they may inquire about your therapy. No information will be provided without a written consent for release of information from you in which, if you choose to release this, your diagnoses and date of service will be the sole information provided unless you specify otherwise. Please be aware that I cannot control how your insurance company uses information about you, and/or your dependent(s) once it is in their possession.

Use of Diagnosis: Some health insurance companies will reimburse clients for mental health services and some will not. In addition, most will require a diagnosis of a mental-health condition and indicate that you must have an "illness" before they will agree to reimburse you. Some conditions for which people seek counseling do not qualify for reimbursement. If a qualifying diagnosis is appropriate in your case, I will inform you of the diagnosis before I submit the diagnosis to the health insurance company. Any diagnosis made will become part of your permanent insurance records.

4. In rare circumstances, therapists can be ordered by a judge to release information. I do my best to keep my clients protected by following the standard ethical practices of keeping case notes brief and refraining from using specific information such as the proper names and details regarding incidents or events which could identify the client or those they come in contact with. The purpose of notes is for our personal use for treatment, not testimony.

Confidentiality also applies to child and adolescent clients. This means that as your child's therapist, I may be privy to information, which you, as a parent, could consider important. With the exception of the above mentioned conditions, confidentiality must be maintained to assure complete honesty, openness, and therapeutic benefit. Please continue to be watchful of your child and continue to trust your instincts and take action when necessary. Therapy does not take the place of parenting, nor does it intend to exclude parents. If your adolescent is participating in therapy with me, it is vital for you and any other parent(s)/legal guardians, and sometimes other immediate family members, to be present and participate consistently in therapy depending upon the discretion of the therapist and whether including such family members would be beneficial for your adolescent. If you have concerns regarding your child, please feel free to discuss these concerns with me directly.

I understand that Dr. Faith Troupe, LMFT solely provides therapeutic services. I understand that she will evaluate and/or treat me with the ultimate goal of helping me move toward wellness and recovery. I also understand that my therapist will not participate in the determination of disability or make specific recommendations on child custody or fitness to parent, but can refer me to another practice, agency or professional that does provide disability and/or custody evaluations.

This contract is an agreement between the interested parties that no party shall attempt to subpoena my testimony or my records for a deposition or court hearing of any kind for any reason. All parties acknowledge that the goal of therapy is the amelioration of psychological distress and interpersonal conflict, and that the process of psychotherapy depends on trust and openness during the therapy sessions.

Therefore it is understood by all parties that if they request my services as a therapist, they are expected not to use information given to me during the therapy process for their own legal purposes or against any of the other parties in a court or judicial setting of any kind.

In the event that I am requested to testify in court on your behalf despite the above agreement, you will be billed at a rate of $350.00 per hour to include travel time, mileage, time preparing notes, forms or files, time directly spent in court, speaking with attorneys or other involved parties, or any other required court testimony responsibilities. Court appearances can be very costly and are not reimbursable by insurance.

Right to request how I contact you. You have the right to request how I communicate with you outside of session. Please indicate on the Intake Form your preferred methods of contact and leave a message.

Right to release your medical records. You may consent in writing to release your records to others. You have the right to revoke this authorization, verbally or in writing, at any time; however, a revocation is not valid to the extent that we acted in reliance on such authorization.

Right to inspect and copy your medical and billing records. You have the right to inspect and obtain a copy of the information contained in your medical records. Under limited circumstance, I may deny your request to inspect and copy records, particularly in matters of couples or family counseling. If you ask for a copy of any information, I reserve the right to charge a reasonable fee for the costs of copying, mailing, and supplies.

Right to add information or amend your medical records. If you feel that information contained in your medical record is incorrect or incomplete, you may ask to add information to amend the record. I will make a decision on your request within 30 days. Under certain circumstances, I may deny your request to add or amend information. If I deny your request, you have a right to file a statement that you disagree with this decision. Your statement and my response will be added to your record. I will require you to submit your request in writing and to provide an explanation concerning the reason for your request.

Right to an accounting of disclosures. You may request an accounting of any disclosures, if any, I have made related to your medical information, except for information used for treatment, payment, or health care operational purposes that I shared with you or your family, or information that you gave us specific consent to release. It also excludes information I was required to release. To receive information regarding disclosures made for a specific time period, please submit your request in writing. I will notify you of the cost involved in preparing this list.

Right to request restrictions on uses and disclosures of your health information. You have the right to ask for restrictions on certain uses and disclosures of your health information. This request must be in writing. However, I am not required to agree to such a request.

Right to file a grievance. Although clients are encouraged to discuss any concerns with me directly, you may file a complaint against me with the organization below should you feel I am in violation of any of these codes of ethics. I abide by the American Association for Marriage and Family Therapy (AAMFT) Code of Ethics, which can be found at the link provided: www.aamft.org/iMIS15/AAMFT/Content/Legal_Ethics/Code_of_Ethics.aspx Individuals will not be retaliated against for filing such a complaint. If you wish to file a complaint, you can contact the North Carolina Marriage and Family Licensing Board PO Box 5549 Cary, NC 27512. Phone: 919.654.6914 | Fax: 919.336.5156 | E-mail:ncmftlb@nc.rr.com

Right to receive changes in policy. You have the right to receive any future policy changes secondary to changes in State and Federal laws.

I understand that I have the following rights with respect to telemedicine:

(1) I have the right to withhold or withdraw consent at any time without affecting my right to future care or treatment nor risking the loss or withdrawal of any program benefits to which I would otherwise be entitled.

(2) The laws that protect the confidentiality of my medical information also apply to telemedicine. As such, I understand that the information disclosed by me during the course of my therapy is generally confidential. However, there are both mandatory and permissive exceptions to confidentiality including, but not limited to: reporting child, elder, and dependent adult abuse; expressed threats of violence towards an ascertainable victim; and where I make my mental or emotional state an issue in a legal proceeding. (See also Office Policies and HIPAA Notice of Privacy Practices forms, provided to me, for more details of confidentiality and other issues.) I also understand that the dissemination of any personally identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without my written consent.

(3) I understand that there are risks and consequences from telemedicine. These may include, but are not limited to, the possibility, despite reasonable efforts on the part of my psychotherapist, that: the transmission of my medical information could be disrupted or distorted by technical failures; the transmission of my medical information could be interrupted by unauthorized persons; the electronic storage of my medical information could be accessed by unauthorized persons and/or misunderstandings can more easily occur, especially when care is delivered in an asynchronous manner. In addition, I understand that telemedicine based services and care may not yield the same results nor be as complete as face-to-face service. I also understand that if my therapist believes I would be better served by another form of psychotherapeutic service (e.g. face-to-face service), I will be referred to a psychotherapist in my area who can provide such service. Finally, I understand that there are potential risks and benefits associated with any form of psychotherapy, and that despite my efforts and the efforts of my psychotherapist, my condition may not improve and in some cases may even get worse.

(4) I understand that I may benefit from telemedicine, but results cannot be guaranteed or assured. The benefits of telemedicine may include, but are not limited to: finding a greater ability to express thoughts and emotions; transportation and travel difficulties are avoided; time constraints are minimized; and there may be a greater opportunity to prepare in advance for therapy sessions.