Wolf
Therapy
Services, Inc.
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Client Bill of Rights Contact Information: My name is Jordon Wolf. I can be contacted through my office by telephone at (847)877-7893. I can also be contacted via email at socialworker@att.net. More information about my practice can be obtained at www.wolftherapy.com. Education and Training: I have a Master’s degree in Social Work from George William’s College of Aurora University. I also have a Bachelor’s degree in Social Work from Northeastern Illinois University. All of my degrees are accredited by the Counsel on Social Work Education. I am a Licensed Clinical Social Worker in Illinois-License # 149-011121. I was trained in hypnotherapy at The Leidecker Institute which is the only state certified school for hypnosis training. I am a Certified Member of the National Guild of Hypnotists and I do annual continuing education to maintain my training at a high level. The National Guild of Hypnotists is the oldest and largest hypnotism organization in the world and its certification is the most widely recognized credential for the professional practice of the hypnotic arts. Notice: AS THE STATE OF ILLINOIS HAS NOT ADOPTED EDUCATIONAL AND TRAINING STANDARDS FOR THE PRACTICE OF HYPNOTISM, THIS STATEMENT OF CREDENTIALS IS FOR INFORMATIONAL PURPOSES ONLY. Hypnotism is a self-regulating profession and its practitioners are not licensed by state governments. I am not a physician nor a licensed health care provider and may not provide a medical diagnosis nor recommend discontinuance of medically prescribed treatments. If a client desires a diagnosis or any other type of treatment from a different practitioner, the client may seek such services at any time. In the event my services are terminated by a client, the client has a right to coordinated transfer of services to another practitioner. A client has a right to refuse hypnotism services at any time. A client has a right to be free of physical, verbal or sexual abuse. A client has a right to know the expected duration of sessions, and may assert any right without retaliation. Fees: The charge for my services is $150 per session unless otherwise arranged. Group rates and package rates can be negotiated on a case by case basis. You will be given 60 days notice of any change in fees. All appointments cancelled on less than 24 hours notice will be billed for. I will also charge if you do not show for a scheduled appointment. ***Payment is expected at time of service*** Insurance: I suggest you think of my services as something that you will pay for personally. That will both protect your privacy and help you value the work you are doing more. In general, insurance companies do not like to cover hypnotic services, and I caution you not to expect them to do so. I will provide you with a receipt for services. You are welcome to submit them to your insurance company on your own. Please be aware that very few insurance companies will pay for this type of service. Confidentiality: My records are confidential and privileged under Illinois law. I will not release any information to anyone without a written authorization from you, except as provided for by law. You have a right to be allowed access to my written record about you. Redress: I am a certified member of the National Guild of Hypnotists, and practice in accordance with its Code of Ethics and Standards. If you have a complaint about my services or behavior that I cannot resolve for you personally, you may contact the National Guild of Hypnotists at P.O. Box 308, Merrimack, NH 03054-0308, (603) 429-9438, to seek redress. Other services than my own may be available to you in the community. You may locate such providers in the telephone book. My Approach: As therapy is a joint effort between therapist and client, a commitment is required by both parties to promote a successful outcome. As the therapist I agree to provide you with the best possible care available. Please understand that different treatment styles work for different people. Although I will always make every effort to provide effective care, I do not guarantee any outcomes of services. From my experience as a Clinical Social Worker, a person’s success is dependent directly on their own commitment to change. Together a treatment plan will be created that will be a roadmap for the therapeutic relationship you are about to begin. We will discuss the plan and use it to help guide us on your journey. I will keep you informed of your progress and communicate with you honestly about recommendations or needed changes to achieve your desired outcomes.
Acknowledgment I have received and read this Client Bill of Rights and understand what I have read. Print Client Name Client Signature Date |
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(847)877-7893
Copyright © 2006
Wolf Therapy Services, Inc. All rights reserved.
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