New Client Forms

 
Download
Client Forms Here

 

 

Grab your 4 initial paperwork forms here.

 

 

Select the Word version to download and complete by computer.  Select the PDF version to view online, print out, and complete by pen.

 

 

Complete forms and bring all to your first appointmentor fax to me at (305) 775 - 5101.

 

 

For your privacy and data protection, do NOT email forms

New Welcome for Intake Process – Roberta Gallagher

 

 

 

 

 

 

Client Medical Info and Confidentiality Form

 

 

 

 

 

 

Roberta Gallagher HIPAA & Privacy Notice

 

 

 

 

 

 

Consent For Use and Disclosure Of Health Information

Frequently Asked Questions

The following are some of the questions I get asked about most often. However, if you have any other questions I have not yet answered below, please feel free to send me a message.

Are You Taking New Clients?

Yes! Although my schedule is quite full, I do have Skype or FaceTime appointments available on these days and times for new clients:

Tuesdays 1 - 4 pm

Wednesdays 9 am  - 12 noon

Limited evening sessions are occasionally available by special request

Session Fees

$200 for sessions of 60-75 minutes 

$150 for sessions of 45-50 minutes

If after the first session we deem that further sessions would be helpful we can discuss package payment structures it at that time.  Until we see whether we are a fit, it doesn't make sense to discuss fees more specifically. 

 

Reduced Fee Accelerated Pace  – Coaching can sometimes be successful when done at an accelerated pace schedule of less frequent, shorter sessions. When appropriate for your issues and processing style, I may be able to offer you a greatly reduced fee starting at $100 per each 35 minute session.  If you think this would best fit your processing and style, call to find out if one of those slots is available. 

 

Sliding Scale -- I maintain a few sliding scale slots for counseling clients who are currently experiencing financial difficulties. The scale slides from $75 to $125 for a 50 minute session. You will choose the actual rate you can sustain for all sessions. If my sliding scale rate won’t work for you, I’ll provide a referral to other services.

Payment information

Whether you are scheduling as an individual or couple, I require all payments prior to our scheduled session. I use PayPal or Venmo as convenient and trusted payment processors. You can use your PayPal balance, or a Mastercard, Discover, or Visa via PayPal, or checking account connected to Venmo. I do not bill clients, and cannot take payment on a monthly basis

Miami relationship expert Roberta Gallagher coaches by Skype
How can I pay with my insurance?

Although I do not submit bills to your health insurance carrier, I will provide coded receipts for you if your insurance is PPO and you wish to file for reimbursement from your own insurance company. Please check with your company and ask about their reimbursement policy for out of network mental health providers.  Coaching sessions are not insurance reimbursable.

What if I need to cancel or reschedule?

My cancellation policy is usual and customary – at least 48 hours notice, or you are responsible for payment of the session. Missed sessions without 48 hour notice must be paid at or before the next scheduled session in order for that session to take place.

What is relationship counseling like?
Miami couples adore counselor Roberta Gallagher

In the first session we will discuss basic issues of confidentiality, session date, day and time.  In the first 2-3 sessions we talk about what are the circumstances that lead you to come in for counseling.  

 

Generally, this is a brief, solution oriented process that lasts 10-12 sessions. Of course if you do not feel a sense of forward momentum after the 3rd or 4th session you may opt to stop. In fact, you may stop at any time you feel the sessions are not worth your time or money.

Therapy sessions are scheduled according to your own needs. The same is true for the length of therapy.  You will know when it's time to taper off, and you must stop at any time you feel the sessions are not worth the time or money.  I prefer that therapy doesn't not end until the three of us discuss it.

Are my sessions confidential?

Therapists are regulated by a professional board of ethics and other statutory bodies whose laws protect the confidentiality of all communications between a client and a psychotherapist. Information is not disclosed without written permission. However, there are the following exceptions to this rule:

 

  • Suspected child abuse or dependent adult or elder abuse.

  • If a client is threatening serious bodily harm to another person/s.

  • If a client intends to harm himself or herself.

 

I will discuss confidentiality with you prior to commencing counseling.

What if we are not married?

I see couples who are engaged, in long term relationships. I also work with LBGT couples.

My partner will not attend counseling.  
Can I come in alone?

Yes, we can also work together and lay the foundation for your work on finding happiness in your relationship. At times one partner may choose to start counseling if the other partner is hesitant. He or she can join later on in the sessions.

I don't know if I want to talk with a stranger
about my relationship.

We can schedule a free half hour phone consultation so that you may ask me questions about counseling and how it can work for.

Give me a call and let’s get started 

Roberta Gallagher, LCSW, LMFT
305 - 775 - 5101

Nothing improves by procrastinating

© 2014 -2019 by Roberta Gallagher

 

Licensed Clinical Social Worker

Licensed Marriage and Family Therapist

Certified Relationship Coach

Social Work Board Certified Diplomate

 

 

Reserve Your Time
with Roberta

If you are worried about the cost of couples counseling, ask if you might qualify for a sliding scale.

South Miami FL 33143

TEL: 305-775-5101

FAX:  305-328-9326

 

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