About this provider
Our mission is to provide clinical mental health counseling to individuals, couples, and families in a Christian Environment. We use a sliding fee scale that starts at $35 and goes up to $125. However, we do not want money to be a factor to prevent clients from getting the help they need, Therefore, we work with clients when they need a fee reduction. In 2019, approximately 47.4% of our clients were below our lowest fee with 21.2% of those at $0. We are currently providing online teletherapy utilizing a HIPAA compliant platform. Our therapists are LPC-MHSPs, LMFTs, Graduate Residents, and Graduate Student Interns.
Pricing Information
https://www.covenantkpt.com/forms-fees-policies
Current Sliding Fee Schedule:
| Household income | Fee |
|---|---|
| $35,000 and below | $35 |
| $35,001-$50,000 | $50 |
| $50,001-$65,000 | $65 |
| $65,001-$80,000 | $80 |
| $80,001-$100,000 | $100 |
| $100,001 and up | $125 |
Clients unable to pay the minimum fee will still be seen and fees will be adjusted based upon the individual or family situation.
Privacy Information
We are bound by HiPAA. We will use WebEx as the HIPAA compliant platform for teletherapy.
Limits of Confidentiality Statement: Initial here: _____
Issues discussed in therapy are important and are generally legally protected as both confidential and “privileged”. However, there are limits to the privilege of confidentiality. These situations include:
- Suspected abuse or neglect of a child, elderly person, or a disabled person
- When your therapist believes you are in danger of harming yourself or others. If you report that you intend to physically injure someone, the law requires your therapist to inform that person as well as the legal authorities.
- If your therapist is ordered by a court to release information as part of a legal involvement in litigation, etc.
- When your insurance company or another third party payee is involved.
- As a result of a natural disaster whereby protected records may become exposed.
- When otherwise required by law.
- When you sign a Release of Information giving your permission for the therapist to share your protected information with a designated person.
For full Informed Consent, please see New Client Forms: https://www.covenantkpt.com/forms-fees-policies
Standard disclaimer for treatment of minors:
Parent/Guardian Consent for Child or Dependent Treatment:
You are reporting that you have legal responsibility for, (name of child) _______________________ and you consent to treatment with (name of therapist) ____________________________ to see previously mentioned child with and/or without you being present in the same session. You understand that you are the holder of confidential privilege-the right to withhold disclosure of private information about your child. However, in the interest of developing a trust relationship between the therapist and your child, you give the therapist permission to reveal or withhold information that in his/her clinical judgment is necessary to best help and protect your child.
Location
441 Clay St. #2, Kingsport, TN 37660, USA
