I, (Client), voluntarily consent for treatment with Carrie T. Ishee, M.A, LPCC, LPAT, ATR-BC, PCC. My right to refuse to consent to admission and treatment was fully explained to me.

Therapy sessions will be arranged with the client and the therapist on the basis of treatment need and scheduling ability. In cases of extreme emergency, special considerations may be applied regarding payment for missed appointments. All payments will be made at the end of each session unless a specific agreement has been made between the therapist and client(s) in writing. Client(s) are required to contact the therapist within twenty-four hours of a scheduled appointment to cancel. The client(s) are expected to pay for any appointments missed when they are not canceled within the twenty-four hours. Fees for services are arranged on a sliding scale based on need and thorough negotiation between the client(s) and the therapist and subject to change based on changes in the financial circumstances of the client(s). The agreed upon fee for services are $110.00 per 50 minute session. Carrie T. Ishee, LPCC, LPAT, ATR-BC, PCC will bill insurance companies directly, but client is responsible for co-pay at time of service. The only insurances taken are BCBSNM and Presbyterian.