Local Time / Timezone
2:56 pm, Sat Apr 20: Kabul (AFT)
12:26 pm, Sat Apr 20: Tirane (CET)
11:26 am, Sat Apr 20: Algiers (CET)
11:26 pm, Fri Apr 19: Pago Pago (SST)
12:26 pm, Sat Apr 20: Andorra (CET)
11:26 am, Sat Apr 20: Luanda (WAT)
6:26 am, Sat Apr 20: Anguilla (AST)
6:26 am, Sat Apr 20: Antarctica - Palmer (CLT)
1:26 pm, Sat Apr 20: Antarctica - Syowa (SYOT)
4:26 pm, Sat Apr 20: Antarctica - Mawson (MAWT)
4:26 pm, Sat Apr 20: Antarctica - Vostok (VOST)
5:26 pm, Sat Apr 20: Antarctica - Davis (DAVT)
6:26 pm, Sat Apr 20: Antarctica - Casey (WST)
8:26 pm, Sat Apr 20: Antarctica - DumontDUrville (DDUT)
10:26 pm, Sat Apr 20: Antarctica - McMurdo (NZST)
10:26 pm, Sat Apr 20: Antarctica - South Pole (NZST)
6:26 am, Sat Apr 20: Antigua (AST)
2:26 pm, Sat Apr 20: Yerevan (AMT)
6:26 am, Sat Apr 20: Aruba (AST)
6:26 pm, Sat Apr 20: Australia - Perth (WST)
7:56 pm, Sat Apr 20: Australia - Adelaide (CST)
7:56 pm, Sat Apr 20: Australia - Broken Hill (CST)
7:56 pm, Sat Apr 20: Australia - Darwin (CST)
8:26 pm, Sat Apr 20: Australia - Brisbane (EST)
8:26 pm, Sat Apr 20: Australia - Hobart (EST)
8:26 pm, Sat Apr 20: Australia - Lindeman (EST)
8:26 pm, Sat Apr 20: Australia - Melbourne (EST)
8:26 pm, Sat Apr 20: Australia - Sydney (EST)
8:56 pm, Sat Apr 20: Australia - Lord Howe (LHST)
12:26 pm, Sat Apr 20: Vienna (CET)
2:26 pm, Sat Apr 20: Baku (AZT)
6:26 am, Sat Apr 20: Nassau (EST)
1:26 pm, Sat Apr 20: Bahrain (AST)
4:26 pm, Sat Apr 20: Dhaka (BDT)
6:26 am, Sat Apr 20: Barbados (AST)
12:26 pm, Sat Apr 20: Minsk (EET)
12:26 pm, Sat Apr 20: Brussels (CET)
4:26 am, Sat Apr 20: Belize (CST)
11:26 am, Sat Apr 20: Porto-Novo (WAT)
7:26 am, Sat Apr 20: Bermuda (AST)
4:26 pm, Sat Apr 20: Thimphu (BTT)
6:26 am, Sat Apr 20: La Paz (BOT)
12:26 pm, Sat Apr 20: Sarajevo (CET)
12:26 pm, Sat Apr 20: Gaborone (CAT)
5:26 am, Sat Apr 20: Eirunepe (ACT)
5:26 am, Sat Apr 20: Rio Branco (ACT)
6:26 am, Sat Apr 20: Boa Vista (AMT)
6:26 am, Sat Apr 20: Cuiaba (AMT)
6:26 am, Sat Apr 20: Manaus (AMT)
6:26 am, Sat Apr 20: Porto Velho (AMT)
7:26 am, Sat Apr 20: Araguaina (BRT)
7:26 am, Sat Apr 20: Belem (BRT)
7:26 am, Sat Apr 20: Fortaleza (BRT)
7:26 am, Sat Apr 20: Maceio (BRT)
7:26 am, Sat Apr 20: Recife (BRT)
7:26 am, Sat Apr 20: Sao Paulo (BRT)
8:26 am, Sat Apr 20: Noronha (FNT)
4:26 pm, Sat Apr 20: Chagos (IOT)
6:26 pm, Sat Apr 20: Brunei (BNT)
1:26 pm, Sat Apr 20: Sofia (EET)
10:26 am, Sat Apr 20: Ouagadougou (GMT)
12:26 pm, Sat Apr 20: Bujumbura (CAT)
6:26 am, Sat Apr 20: Curacao (AST)
5:26 pm, Sat Apr 20: Phnom Penh (ICT)
11:26 am, Sat Apr 20: Douala (WAT)
2:26 am, Sat Apr 20: Dawson (PST)
2:26 am, Sat Apr 20: Whitehorse (PST)
3:26 am, Sat Apr 20: Dawson Creek (MST)
3:26 am, Sat Apr 20: Vancouver (PST)
4:26 am, Sat Apr 20: Regina (CST)
4:26 am, Sat Apr 20: Swift Current (CST)
4:26 am, Sat Apr 20: Cambridge Bay (MST)
4:26 am, Sat Apr 20: Edmonton (MST)
4:26 am, Sat Apr 20: Inuvik (MST)
4:26 am, Sat Apr 20: Yellowknife (MST)
5:26 am, Sat Apr 20: Rainy River (CST)
5:26 am, Sat Apr 20: Winnipeg (CST)
5:26 am, Sat Apr 20: Rankin Inlet (EST)
6:26 am, Sat Apr 20: Iqaluit (EST)
6:26 am, Sat Apr 20: Montreal (EST)
6:26 am, Sat Apr 20: Nipigon (EST)
6:26 am, Sat Apr 20: Pangnirtung (EST)
6:26 am, Sat Apr 20: Thunder Bay (EST)
7:26 am, Sat Apr 20: Glace Bay (AST)
7:26 am, Sat Apr 20: Goose Bay (AST)
7:26 am, Sat Apr 20: Halifax (AST)
7:56 am, Sat Apr 20: St Johns (NST)
9:26 am, Sat Apr 20: Cape Verde (CVT)
5:26 am, Sat Apr 20: Cayman (EST)
11:26 am, Sat Apr 20: Bangui (WAT)
11:26 am, Sat Apr 20: Ndjamena (WAT)
4:26 am, Sat Apr 20: Easter (EAST)
6:26 am, Sat Apr 20: Santiago (CLT)
6:26 pm, Sat Apr 20: Chongqing (CST)
6:26 pm, Sat Apr 20: Harbin (CST)
6:26 pm, Sat Apr 20: Kashgar (CST)
6:26 pm, Sat Apr 20: Shanghai (CST)
6:26 pm, Sat Apr 20: Urumqi (CST)
5:26 pm, Sat Apr 20: Christmas (CXT)
4:56 pm, Sat Apr 20: Cocos (CCT)
5:26 am, Sat Apr 20: Bogota (COT)
1:26 pm, Sat Apr 20: Comoro (EAT)
11:26 am, Sat Apr 20: Brazzaville (WAT)
11:26 am, Sat Apr 20: Kinshasa (WAT)
12:26 pm, Sat Apr 20: Lubumbashi (CAT)
12:26 am, Sat Apr 20: Rarotonga (CKT)
4:26 am, Sat Apr 20: Costa Rica (CST)
10:26 am, Sat Apr 20: Abidjan (GMT)
12:26 pm, Sat Apr 20: Zagreb (CET)
6:26 am, Sat Apr 20: Havana (CST)
1:26 pm, Sat Apr 20: Nicosia (EET)
12:26 pm, Sat Apr 20: Prague (CET)
12:26 pm, Sat Apr 20: Copenhagen (CET)
1:26 pm, Sat Apr 20: Djibouti (EAT)
6:26 am, Sat Apr 20: Dominica (AST)
6:26 am, Sat Apr 20: Santo Domingo (AST)
4:26 am, Sat Apr 20: Galapagos (GALT)
5:26 am, Sat Apr 20: Guayaquil (ECT)
12:26 pm, Sat Apr 20: Cairo (EET)
4:26 am, Sat Apr 20: El Salvador (CST)
11:26 am, Sat Apr 20: Malabo (WAT)
1:26 pm, Sat Apr 20: Tallinn (EET)
1:26 pm, Sat Apr 20: Addis Ababa (EAT)
6:26 am, Sat Apr 20: Stanley (FKT)
10:26 pm, Sat Apr 20: Fiji (FJT)
1:26 pm, Sat Apr 20: Helsinki (EET)
12:26 pm, Sat Apr 20: Paris (CET)
7:26 am, Sat Apr 20: Cayenne (GFT)
12:26 am, Sat Apr 20: Tahiti (TAHT)
12:56 am, Sat Apr 20: Marquesas (MART)
1:26 am, Sat Apr 20: Gambier (GAMT)
3:26 pm, Sat Apr 20: Kerguelen (TFT)
11:26 am, Sat Apr 20: Libreville (WAT)
10:26 am, Sat Apr 20: Banjul (GMT)
2:26 pm, Sat Apr 20: Tbilisi (GET)
12:26 pm, Sat Apr 20: Berlin (CET)
10:26 am, Sat Apr 20: Accra (GMT)
12:26 pm, Sat Apr 20: Gibraltar (CET)
1:26 pm, Sat Apr 20: Athens (EET)
7:26 am, Sat Apr 20: Thule (AST)
8:26 am, Sat Apr 20: Godthab (WGT)
10:26 am, Sat Apr 20: Scoresbysund (EGT)
10:26 am, Sat Apr 20: Danmarkshavn (GMT)
6:26 am, Sat Apr 20: Grenada (AST)
6:26 am, Sat Apr 20: Guadeloupe (AST)
8:26 pm, Sat Apr 20: Guam (ChST)
4:26 am, Sat Apr 20: Guatemala (CST)
10:26 am, Sat Apr 20: Conakry (GMT)
10:26 am, Sat Apr 20: Bissau (GMT)
6:26 am, Sat Apr 20: Guyana (GYT)
6:26 am, Sat Apr 20: Port-au-Prince (EST)
12:26 pm, Sat Apr 20: Vatican (CET)
4:26 am, Sat Apr 20: Tegucigalpa (CST)
6:26 pm, Sat Apr 20: Hong Kong (HKT)
12:26 pm, Sat Apr 20: Budapest (CET)
10:26 am, Sat Apr 20: Reykjavik (GMT)
5:26 pm, Sat Apr 20: Jakarta (WIT)
5:26 pm, Sat Apr 20: Pontianak (WIT)
7:26 pm, Sat Apr 20: Jayapura (EIT)
1:56 pm, Sat Apr 20: Tehran (IRT)
1:26 pm, Sat Apr 20: Baghdad (AST)
11:26 am, Sat Apr 20: Dublin (GMT)
1:26 pm, Sat Apr 20: Jerusalem (IST)
12:26 pm, Sat Apr 20: Rome (CET)
5:26 am, Sat Apr 20: Jamaica (EST)
7:26 pm, Sat Apr 20: Tokyo (JST)
12:26 pm, Sat Apr 20: Amman (EET)
2:26 pm, Sat Apr 20: Aqtau (AQTT)
3:26 pm, Sat Apr 20: Aqtobe (AQTT)
4:26 pm, Sat Apr 20: Almaty (ALMT)
1:26 pm, Sat Apr 20: Nairobi (EAT)
10:26 pm, Sat Apr 20: Tarawa (GILT)
11:26 pm, Sat Apr 20: Enderbury (PHOT)
12:26 am, Sun Apr 21: Kiritimati (LINT)
7:26 pm, Sat Apr 20: Pyongyang (KST)
7:26 pm, Sat Apr 20: Seoul (KST)
1:26 pm, Sat Apr 20: Kuwait (AST)
3:26 pm, Sat Apr 20: Bishkek (KGT)
5:26 pm, Sat Apr 20: Vientiane (ICT)
1:26 pm, Sat Apr 20: Riga (EET)
1:26 pm, Sat Apr 20: Beirut (EET)
12:26 pm, Sat Apr 20: Maseru (SAST)
10:26 am, Sat Apr 20: Monrovia (GMT)
12:26 pm, Sat Apr 20: Tripoli (EET)
12:26 pm, Sat Apr 20: Vaduz (CET)
1:26 pm, Sat Apr 20: Vilnius (EET)
12:26 pm, Sat Apr 20: Luxembourg (CET)
12:26 pm, Sat Apr 20: Skopje (CET)
1:26 pm, Sat Apr 20: Antananarivo (EAT)
12:26 pm, Sat Apr 20: Blantyre (CAT)
6:26 pm, Sat Apr 20: Kuala Lumpur (MYT)
6:26 pm, Sat Apr 20: Kuching (MYT)
3:26 pm, Sat Apr 20: Maldives (MVT)
10:26 am, Sat Apr 20: Bamako (GMT)
12:26 pm, Sat Apr 20: Malta (CET)
10:26 pm, Sat Apr 20: Kwajalein (MHT)
10:26 pm, Sat Apr 20: Majuro (MHT)
6:26 am, Sat Apr 20: Martinique (AST)
10:26 am, Sat Apr 20: Nouakchott (GMT)
2:26 pm, Sat Apr 20: Mauritius (MUT)
1:26 pm, Sat Apr 20: Mayotte (EAT)
3:26 am, Sat Apr 20: Chihuahua (MST)
3:26 am, Sat Apr 20: Hermosillo (MST)
3:26 am, Sat Apr 20: Mazatlan (MST)
3:26 am, Sat Apr 20: Tijuana (PST)
4:26 am, Sat Apr 20: Cancun (CST)
4:26 am, Sat Apr 20: Merida (CST)
4:26 am, Sat Apr 20: Mexico City (CST)
4:26 am, Sat Apr 20: Monterrey (CST)
9:26 pm, Sat Apr 20: Kosrae (KOST)
1:26 pm, Sat Apr 20: Chisinau (EET)
12:26 pm, Sat Apr 20: Monaco (CET)
5:26 pm, Sat Apr 20: Hovd (HOVT)
6:26 pm, Sat Apr 20: Ulaanbaatar (ULAT)
7:26 pm, Sat Apr 20: Choibalsan (CHOT)
6:26 am, Sat Apr 20: Montserrat (AST)
11:26 am, Sat Apr 20: Casablanca (WET)
12:26 pm, Sat Apr 20: Maputo (CAT)
4:56 pm, Sat Apr 20: Rangoon (MMT)
11:26 am, Sat Apr 20: Windhoek (WAT)
10:26 pm, Sat Apr 20: Nauru (NRT)
12:26 pm, Sat Apr 20: Amsterdam (CET)
9:26 pm, Sat Apr 20: Noumea (NCT)
10:26 pm, Sat Apr 20: Auckland (NZST)
11:11 pm, Sat Apr 20: Chatham (CHAST)
4:26 am, Sat Apr 20: Managua (CST)
11:26 am, Sat Apr 20: Niamey (WAT)
11:26 am, Sat Apr 20: Lagos (WAT)
11:26 pm, Fri Apr 19: Niue (NUT)
9:56 pm, Sat Apr 20: Norfolk (NFT)
8:26 pm, Sat Apr 20: Saipan (ChST)
12:26 pm, Sat Apr 20: Oslo (CET)
2:26 pm, Sat Apr 20: Muscat (GST)
3:26 pm, Sat Apr 20: Karachi (PKT)
7:26 pm, Sat Apr 20: Palau (PWT)
1:26 pm, Sat Apr 20: Gaza (EET)
5:26 am, Sat Apr 20: Panama (EST)
8:26 pm, Sat Apr 20: Port Moresby (PGT)
6:26 am, Sat Apr 20: Asuncion (PYT)
5:26 am, Sat Apr 20: Lima (PET)
6:26 pm, Sat Apr 20: Manila (PHT)
2:26 am, Sat Apr 20: Pitcairn (PST)
12:26 pm, Sat Apr 20: Warsaw (CET)
10:26 am, Sat Apr 20: Azores (AZOT)
11:26 am, Sat Apr 20: Madeira (WET)
11:26 am, Sat Apr 20: Lisbon (WET)
6:26 am, Sat Apr 20: Puerto Rico (AST)
1:26 pm, Sat Apr 20: Qatar (AST)
12:26 pm, Sat Apr 20: Belgrade (CET)
2:26 pm, Sat Apr 20: Reunion (RET)
1:26 pm, Sat Apr 20: Bucharest (EET)
12:26 pm, Sat Apr 20: Kaliningrad (EET)
1:26 pm, Sat Apr 20: Moscow (MSK)
2:26 pm, Sat Apr 20: Samara (SAMT)
3:26 pm, Sat Apr 20: Yekaterinburg (YEKT)
4:26 pm, Sat Apr 20: Novosibirsk (NOVT)
4:26 pm, Sat Apr 20: Omsk (OMST)
5:26 pm, Sat Apr 20: Krasnoyarsk (KRAT)
6:26 pm, Sat Apr 20: Irkutsk (IRKT)
7:26 pm, Sat Apr 20: Yakutsk (YAKT)
8:26 pm, Sat Apr 20: Sakhalin (SAKT)
8:26 pm, Sat Apr 20: Vladivostok (VLAT)
9:26 pm, Sat Apr 20: Magadan (MAGT)
10:26 pm, Sat Apr 20: Anadyr (ANAT)
10:26 pm, Sat Apr 20: Kamchatka (PETT)
12:26 pm, Sat Apr 20: Kigali (CAT)
10:26 am, Sat Apr 20: St Helena (GMT)
6:26 am, Sat Apr 20: St Kitts (AST)
6:26 am, Sat Apr 20: St Lucia (AST)
8:26 am, Sat Apr 20: Miquelon (PMST)
6:26 am, Sat Apr 20: St Vincent (AST)
11:26 pm, Fri Apr 19: Apia (WST)
12:26 pm, Sat Apr 20: San Marino (CET)
10:26 am, Sat Apr 20: Sao Tome (GMT)
1:26 pm, Sat Apr 20: Riyadh (AST)
10:26 am, Sat Apr 20: Dakar (GMT)
2:26 pm, Sat Apr 20: Mahe (SCT)
10:26 am, Sat Apr 20: Freetown (GMT)
6:26 pm, Sat Apr 20: Singapore (SGT)
12:26 pm, Sat Apr 20: Bratislava (CET)
12:26 pm, Sat Apr 20: Ljubljana (CET)
9:26 pm, Sat Apr 20: Guadalcanal (SBT)
1:26 pm, Sat Apr 20: Mogadishu (EAT)
12:26 pm, Sat Apr 20: Johannesburg (SAST)
8:26 am, Sat Apr 20: South Georgia (GST)
11:26 am, Sat Apr 20: Canary (WET)
12:26 pm, Sat Apr 20: Ceuta (CET)
12:26 pm, Sat Apr 20: Madrid (CET)
4:26 pm, Sat Apr 20: Colombo (LKT)
1:26 pm, Sat Apr 20: Khartoum (EAT)
7:26 am, Sat Apr 20: Paramaribo (SRT)
12:26 pm, Sat Apr 20: Arctic - Longyearbyen (CET)
12:26 pm, Sat Apr 20: Mbabane (SAST)
12:26 pm, Sat Apr 20: Stockholm (CET)
12:26 pm, Sat Apr 20: Zurich (CET)
12:26 pm, Sat Apr 20: Damascus (EET)
6:26 pm, Sat Apr 20: Taipei (CST)
3:26 pm, Sat Apr 20: Dushanbe (TJT)
1:26 pm, Sat Apr 20: Dar es Salaam (EAT)
5:26 pm, Sat Apr 20: Bangkok (ICT)
7:26 pm, Sat Apr 20: Dili (TPT)
10:26 am, Sat Apr 20: Lome (GMT)
12:26 am, Sat Apr 20: Fakaofo (TKT)
11:26 pm, Sat Apr 20: Tongatapu (TOT)
6:26 am, Sat Apr 20: Port of Spain (AST)
11:26 am, Sat Apr 20: Tunis (CET)
12:26 pm, Sat Apr 20: Istanbul (EET)
3:26 pm, Sat Apr 20: Ashgabat (TMT)
6:26 am, Sat Apr 20: Grand Turk (EST)
10:26 pm, Sat Apr 20: Funafuti (TVT)
1:26 pm, Sat Apr 20: Kampala (EAT)
12:26 pm, Sat Apr 20: Simferopol (EET)
1:26 pm, Sat Apr 20: Kiev (EET)
1:26 pm, Sat Apr 20: Uzhgorod (EET)
1:26 pm, Sat Apr 20: Zaporozhye (EET)
2:26 pm, Sat Apr 20: Dubai (GST)
11:26 am, Sat Apr 20: London (GMT)
12:26 am, Sat Apr 20: Honolulu (HST)
1:26 am, Sat Apr 20: Adak (HAST)
2:26 am, Sat Apr 20: Anchorage (AKST)
2:26 am, Sat Apr 20: Juneau (AKST)
2:26 am, Sat Apr 20: Nome (AKST)
2:26 am, Sat Apr 20: Yakutat (AKST)
3:26 am, Sat Apr 20: Phoenix (MST)
3:26 am, Sat Apr 20: Los Angeles (PST)
4:26 am, Sat Apr 20: Boise (MST)
4:26 am, Sat Apr 20: Denver (MST)
4:26 am, Sat Apr 20: Shiprock (MST)
5:26 am, Sat Apr 20: Chicago (CST)
5:26 am, Sat Apr 20: Indiana - Knox (CST)
5:26 am, Sat Apr 20: Menominee (CST)
5:26 am, Sat Apr 20: North Dakota - Center (CST)
6:26 am, Sat Apr 20: Detroit (EST)
6:26 am, Sat Apr 20: Indiana - Indianapolis (EST)
6:26 am, Sat Apr 20: Indiana - Marengo (EST)
6:26 am, Sat Apr 20: Indiana - Vevay (EST)
6:26 am, Sat Apr 20: Kentucky - Louisville (EST)
6:26 am, Sat Apr 20: Kentucky - Monticello (EST)
6:26 am, Sat Apr 20: New York (EST)
11:26 pm, Fri Apr 19: Midway (SST)
12:26 am, Sat Apr 20: Johnston (HST)
10:26 pm, Sat Apr 20: Wake (WAKT)
7:26 am, Sat Apr 20: Montevideo (UYT)
3:26 pm, Sat Apr 20: Samarkand (TMT)
3:26 pm, Sat Apr 20: Tashkent (UZT)
9:26 pm, Sat Apr 20: Efate (VUT)
6:26 am, Sat Apr 20: Caracas (VET)
6:26 am, Sat Apr 20: Tortola (AST)
6:26 am, Sat Apr 20: St Thomas (AST)
10:26 pm, Sat Apr 20: Wallis (WFT)
11:26 am, Sat Apr 20: El Aaiun (WET)
1:26 pm, Sat Apr 20: Aden (AST)
12:26 pm, Sat Apr 20: Lusaka (CAT)
12:26 pm, Sat Apr 20: Harare (CAT)
Office Policies & General Information Agreement for Psychotherapy Services
This form provides you (patient) with information that is
additional to that detailed in the HIPAA Notice of Privacy
Practices. The Health Insurance Portability and Accountability Act
(HIPAA) is a federal law that provides new privacy protections and
new patient rights with regard to the use and disclosure of your
Protected Health Information (PHI) used for the purpose of
treatment, payment, and health care operations. HIPAA requires that
your signature acknowledge that this information has been provided
to you. Please read the documents carefully. If you have any
questions, we can discuss them during our next session. When you
sign this document, it will also represent an agreement between us.
You may revoke this Agreement in writing at any time. That
revocation will be binding on me unless I have taken action in
reliance on it; if there are obligations imposed on me by your
health insurer in order to process or substantiate claims made
under your policy; or if you have not satisfied any financial
obligations you have incurred.
CONFIDENTIALITY: All information disclosed within sessions and the
written records pertaining to those sessions are confidential and
may not be revealed to anyone without your (patient's) written
permission, except where disclosure is required by law. Most of the
provisions explaining when the law requires disclosure are
described to you in the Notice of Privacy Practices.
When Disclosure Is Required By Law
Some of the circumstances where disclosure is required by the law
are: where there is a reasonable suspicion of child, dependent, or
elder abuse or neglect; and where a patient presents a danger to
self, to others, to property, or is gravely disabled (for more
details see also Notice of Privacy Practices form).
When Disclosure May Be Required
Disclosure may be required pursuant to a legal proceeding. If you
place your mental status at issue in litigation initiated by you,
the defendant may have the right to obtain the psychotherapy
records and/or testimony by Travis W. Atkinson In couple and family
therapy, or when different family members are seen individually,
confidentiality and privilege do not apply between the couple or
among family members while in active treatment together. Travis W.
Atkinson will use his clinical judgment when revealing such
information. Travis W. Atkinson will not release records to any
outside party unless he is authorized to do so by all adult family
members who were part of the treatment.
Emergencies
If there is an emergency during our work together, or in the future
after termination, where Travis W. Atkinson becomes concerned about
your personal safety, the possibility of you injuring someone else,
or about you receiving proper psychiatric care, he will do whatever
he can within the limits of the law, to prevent you from injuring
yourself or others and to ensure that you receive the proper
medical care. For this purpose, he may also contact the person
whose name you have provided on the biographical sheet.
Health Insurance & Confidentiality of Records
Disclosure of confidential information may be required by your
health insurance carrier or HMO/PPO/MCO/EAP in order to process the
claims. If you so instruct Travis W. Atkinson, only the minimum
necessary information will be communicated to the carrier. Unless
authorized by you explicitly the Psychotherapy Notes will not be
disclosed to your insurance carrier. Travis W. Atkinson has no
control or knowledge over what insurance companies do with the
information he submits or who has access to this information. You
must be aware that submitting a mental health invoice for
reimbursement carries a certain amount of risk to confidentiality,
privacy, or to future eligibility to obtain health or life
insurance. The risk stems from the fact that mental health
information is entered into insurance companies' computers and soon
will also be reported to the, congress-approved, National Medical
Data Bank. Accessibility to companies' computers or to the National
Medical Data Bank database is always in question, as computers are
inherently vulnerable to break-ins and unauthorized access. Medical
data has been reported to have been sold, stolen, or accessed by
enforcement agencies; therefore, confidentiality and how submitted
information will be used cannot be guaranteed.
Confidentiality of E-mail, Cell Phone, text and Faxes
Communication
It is very important to be aware that e-mail, cell phone
communication, and text can be relatively easily accessed by
unauthorized people and hence, the privacy and confidentiality of
such communication can be compromised. E-mails, in particular, are
vulnerable to such unauthorized access due to the fact that servers
have unlimited and direct access to all e-mails that go through
them. Faxes can easily be sent erroneously to the wrong address.
Please notify Travis W. Atkinson at the beginning of treatment if
you decide to avoid or limit in any way the use of any or all of
the above-mentioned communication devices. Please do not use
e-mail,text or faxes for emergencies.
Litigation Limitation
Due to the nature of the therapeutic process and the fact that it
often involves making a full disclosure with regard to many matters
which may be of a confidential nature, it is agreed that should
there be legal proceedings (such as, but not limited to divorce and
custody disputes, injuries, lawsuits, etc.), neither you (patient)
nor your attorney, nor anyone else acting on your behalf will call
on Travis W. Atkinson to testify in court or at any other
proceeding, nor will a disclosure of the psychotherapy notes be
requested.
Consultation
Travis W. Atkinson consults regularly with other professionals
regarding his patients; however, the patient's name or other
identifying information is never mentioned. The patient's identity
remains completely anonymous, and confidentiality is fully
maintained.
* Considering all of the above exclusions, if it is still
appropriate, upon your request, Travis W. Atkinson will release
information to any agency/person you specify unless Travis W.
Atkinson concludes that releasing such information might be harmful
in any way.
TELEPHONE & EMERGENCY PROCEDURES
Due to his work schedule, Travis W. Atkinson is often not
immediately available. During his office hours, he will probably
not be available to answer the phone or respond to email or texts
when he is with patients. When Travis W. Atkinson is unavailable,
the telephone is answered by a voicemail system that he monitors
frequently. Mr. Travis W. Atkinson will make every effort to return
your call within 24 hours, with the exception of weekends and
holidays. If you need to contact Travis W. Atkinson between
sessions, please call (212) 725-7774. If an emergency situation
arises, please indicate it clearly in your message. If you need to
talk to someone right away, you can call Travis W. Atkinson at
(212)933-9335, or the Mental Health Help line (212) 222-7666, or
the New York City Crisis Intervention Line (212) 219-5599, or the
Police (911).
PAYMENTS & INSURANCE REIMBURSEMENT
Patients are expected to pay the fee at the end of each session
unless other arrangements have been made. Fee increases may occur,
usually on a yearly basis; in the event of an increase, you will be
notified at least fifteen (15) days prior to the increase. Other
services lasting longer than 5 minutes, such as telephone
conversations, email messages, text messages, site visits, report
writing and reading, consultation with other professionals, release
of information, reading records, longer sessions, travel time, etc.
will be charged at the same rate, pro-rated, unless indicated and
agreed otherwise. Please notify Travis W. Atkinson if any problem
arises during the course of therapy regarding your ability to make
timely payments. Patients who carry insurance should remember that
professional services are rendered and charged to the patients
directly, and not to the insurance companies. Unless agreed upon
differently, Travis W. Atkinson will provide access for you to
download or print your statements for insurance reimbursement
through this site, if you choose. Please allow at least two weeks
for records to be updated. As was indicated in the section, Health
Insurance & Confidentiality of Records, you must be aware that
submitting a mental health invoice for reimbursement carries a
certain amount of risk. Not all issues/conditions/problems, which
are the focus of psychotherapy, are reimbursed by insurance
companies. It is your responsibility to verify the specifics of
your coverage.
MEDIATION & ARBITRATION
All disputes arising out of or in relation to this agreement to
provide psychotherapy services shall first be referred to
mediation, before, and as a pre-condition of, the initiation of
arbitration. The mediator shall be a neutral third party chosen by
agreement of Travis W. Atkinson and patient(s). The cost of such
mediation, if any, shall be split equally, unless otherwise agreed.
In the event that mediation is unsuccessful, any unresolved
controversy related to this agreement should be submitted to and
settled by binding arbitration in Manhattan County, New York City
in accordance with the rules of the American Arbitration
Association which are in effect at the time the demand for
arbitration is filed. Notwithstanding the foregoing, in the event
that your account is overdue (unpaid) and there is no agreement on
a payment plan, Travis W. Atkinson can use legal means (court,
collection agency, etc.) to obtain payment. The prevailing party in
arbitration or collection proceedings shall be entitled to recover
a reasonable sum for attorneys' fees. In the case of arbitration,
the arbitrator will determine that sum.
THE PROCESS OF THERAPY/EVALUATION
Participation in therapy can result in a number of benefits to you,
including improving interpersonal relationships and resolution of
the specific concerns that led you to seek therapy. Working toward
these benefits, however, requires effort on your part.
Psychotherapy requires your very active involvement, honesty, and
openness in order to change your thoughts, feelings and/or
behavior. Travis W. Atkinson will ask for your feedback and views
on your therapy, its progress, and other aspects of the therapy and
will expect you to respond openly and honestly. Sometimes more than
one approach can be helpful in dealing with a certain situation.
During evaluation or therapy, remembering or talking about
unpleasant events, feelings, or thoughts can result in your
experiencing considerable discomfort or strong feelings of anger,
sadness, worry, fear, shame, etc. or experiencing anxiety,
depression, insomnia, etc. Travis W. Atkinson may challenge some of
your assumptions or perceptions or propose different ways of
looking at, thinking about, or handling situations that can cause
you to feel very upset, angry, depressed, challenged, or
disappointed. Attempting to resolve issues that brought you to
therapy in the first place, such as personal or interpersonal
relationships, may result in changes that were not originally
intended. Psychotherapy may result in decisions about changing
behaviors, employment, substance use, schooling, housing, or
relationships. Sometimes a decision that is positive for one family
member is viewed quite negatively by another family member. Change
will sometimes be easy and swift, and may also be slow and even
frustrating, depending on the context. There is no guarantee that
psychotherapy will yield positive or intended results. During the
course of therapy, Travis W. Atkinson is likely to draw on various
psychological approaches according, in part, to the problem that is
being treated and his assessment of what will best benefit you.
These approaches include schema, emotionally focused,
cognitive-behavioral, mindsight, Gottman method couples therapy,
psychodynamic, existential, system/family, developmental (adult,
child, family), gestalt, eye movement desensitization and
reprocessing, or psycho-educational.
Discussion of Treatment Plan
Within a reasonable period of time after the initiation of
treatment, Travis W. Atkinson will discuss with you (patient) his
working understanding of the problem, treatment plan, therapeutic
objectives, and his view of the possible outcomes of treatment. If
you have any unanswered questions about any of the procedures used
in the course of your therapy, their possible risks, Travis W.
Atkinson's expertise in employing them, or about the treatment
plan, please ask and you will be answered fully. You also have the
right to ask about other treatments for your condition and their
risks and benefits. If you could benefit from any treatment that
Travis W. Atkinson does not provide, he has an ethical obligation
to assist you in obtaining those treatments.
Termination
As set forth above, after the first couple of meetings, Travis W.
Atkinson will assess if he can be of benefit to you. Travis W.
Atkinson does not accept patients who, in his opinion, he cannot
help. In such a case, he will give you a number of referrals that
you can contact. If at any point during psychotherapy, Travis W.
Atkinson assesses that he is not effective in helping you reach the
therapeutic goals, he is obliged to discuss it with you and, if
appropriate, to terminate treatment. In such a case, he would give
you a number of referrals that may be of help to you. If you
request it and authorize it in writing, Travis W. Atkinson will
talk to the psychotherapist of your choice in order to help with
the transition. If at any time you want another professional's
opinion or wish to consult with another therapist, Travis W.
Atkinson will assist you in finding someone qualified, and, if he
has your written consent, he will provide her or him with the
essential information needed. You have the right to terminate
therapy at any time. Ideally, please discuss your termination
decision at least one session prior to the final session to allow
preparation for a summary session by Travis W. Atkinson If you
choose to do so, Travis W. Atkinson will offer to provide you with
names of other qualified professionals whose services you might
prefer.
Dual Relationships
Not all dual relationships are unethical or avoidable. Therapy
never involves sexual or any other dual relationship that impairs
Travis W. Atkinson's objectivity, clinical judgment, or therapeutic
effectiveness or can be exploitative in nature. Travis W. Atkinson
will assess carefully before entering into non-sexual and
non-exploitative dual relationships with patients. The possibility
exists that patients may know each other and Travis W. Atkinson
from the community. Consequently you may bump into someone you know
in the waiting room or into Travis W. Atkinson out in the
community. Travis W. Atkinson will never acknowledge working
therapeutically with anyone without his/her written permission. It
is possible that some patients may choose Travis W. Atkinson as
their therapist because they know him before they enter into
therapy with him and/or are aware of his stance on a topic.
Nevertheless, Travis W. Atkinson will discuss with you, his
patient/s, the often-existing complexities, potential benefits, and
difficulties that may be involved in such relationships. Dual or
multiple relationships can enhance therapeutic effectiveness but
can also detract from it and often it is impossible to know that
ahead of time. It is your, the patient's, responsibility to
communicate to Travis W. Atkinson if the dual relationship becomes
uncomfortable for you in any way. Travis W. Atkinson will always
listen carefully and respond accordingly to your feedback. Travis
W. Atkinson will discontinue the dual relationship if he finds it
interfering with the effectiveness of the therapeutic process or
the welfare of the patient and, of course, you can do the same at
any time.
CANCELLATION
Since scheduling of an appointment involves the reservation of time
specifically for you, a minimum of 48 hours (2 day) notice is
required for re-scheduling or canceling an appointment. Unless we
reach a different agreement, the full fee of the session will be
charged for sessions missed without such notification on the credit
card used to reserve the session. Please be aware that most
insurance companies do not reimburse for missed sessions.
I have read the above Agreement and Office Policies and General
Information carefully; I understand and agree with them.