1. Welcome & Purpose of This Document

I'm honored you've chosen to begin (or continue) your healing work here. Welcome. I'm truly glad you're here. Starting therapy is a meaningful step, and my goal is to ensure you feel informed, respected, and supported every step of the way.

This document outlines how we will work together - what you can expect from me, what I expect from you, and the practical and legal agreements that keep our work safe and ethical.

It covers:

      -  My approach to counseling and the methods I use

      -  The services I offer and how to access them

      -  Policies for scheduling, fees, communication, and privacy

      -  Your rights and responsibilities as a client

      -  Important information about confidentiality, risks, and benefits

I encourage you to read through it carefully and bring up any questions or concerns. We can discuss anything you'd like to clarify, and you may request a copy at any time. Our work together is a collaboration - and this agreement is one way we set a strong, clear foundation for your healing process.

2. Contact Information & Emergencies

I want you to know how to reach me - and what to do if you need urgent help outside of our sessions.

You can contact me in the following ways:

      Phone or text:+1 (231) 735-8338 x108

      Email: kelly@healingartscounseling.com - best for scheduling or sharing short resources

      Mailing Address: 3301 Veterans Dr., Suite 126, Traverse City, MI 49684

Response Time:

I make every effort to respond to messages within 24 business hours. Messages received in the evening, on weekends, or during holidays may be returned the next business day.

If you are in crisis or need immediate support, please do not wait for me to respond. Therapy is not a 24/7 emergency service, and I may not always be available right away.

If you are experiencing an emergency or are at risk of harming yourself or someone else, please:

   - Connect with the 988 Suicide & Crisis Lifeline which provides free, confidential, and 24/7 support through a national network of local crisis centers. You can connect with a trained counselor by calling or texting 988, or visiting 988lifeline.org.

   - Text "HOME" to 741741 (Crisis Text Line)

   - Call 911 or go to your nearest emergency room if you are unsafe

   - Call a trusted friend or family member for support

We will also keep a conversation going in therapy about your personal support plan - people, resources, and strategies you can turn to between sessions if needed.

3. Services Offered

My goal is to provide you with care that truly fits your needs - whether that's individual therapy, working alongside a partner or family member, connecting with others in a group setting, or receiving brief support between sessions. I also offer a variety of integrative, body-mind modalities that support the whole person, addressing mental, emotional, physical, relational, and spiritual well-being.

   Therapy & Counseling Services:

- Individual counseling - 50 minutes

      - Joint/family sessions - 75 minutes

      - Therapeutic group counseling - 90 minutes

      - Initial intake sessions - may require extra time, billed in 15-minute increments

      - Crisis coaching - Generally 15 minutes by phone or text included; calls over 30 minutes are billed as a session

Between-Session Support:

Client Portal access - A secure, HIPAA-compliant online space for messaging, accessing treatment documents, self-scheduling, reviewing billing history, making payments, finding additional therapeutic resources, and keeping an encrypted journal

Between-session contact - Available by phone, text, or email; I aim to respond within 2 hours whenever possible

Integrative & Body-Mind Modalities:
May include Brainspotting, yoga and breath work, neuromuscular exercises, guided meditations, creative art prompts, and other somatic or mindfulness-based practices.

Over the course of our work together, we may draw on a combination of modalities based on your goals, preferences, and clinical needs. These approaches can be used individually or in combination, and will be adjusted as needed to best support your progress, resilience, and overall well-being.

4. My Education & Credentials 

I bring both formal education and years of direct clinical experience to my work. My training has given me a strong foundation in psychology, counseling, and integrative therapeutic approaches, and I continue to deepen my skills through advanced training, supervision, and ongoing study.

  - B.A. in Psychology & Ethnic Studies - The Evergreen State College

  - M.S. in Mental Health Counseling - Walden University, 2010

  - Licensed Professional Counselor (LPC) - Michigan (#6401012209)

If you ever have concerns about my services, you can contact: Michigan Department of Licensing and Regulatory Affairs Health Professions Division at P.O. Box 30670, Lansing, MI 48909 or by calling  (517) 373-9196.

5. My Approach to Counseling

I believe counseling can be a powerful catalyst for change - a space where you can explore, heal, and grow in ways that feel authentic and sustainable. My approach isperson-centered, relationship-based, and collaborative, meaning we work together as equal partners in your healing process.

I draw from both traditional psychotherapy and body-mind, evidence-based techniques, creating a process that honors the connection between mind, body, and spirit. Sessions are guided by your needs, your pace, and your goals - and I adapt my approach to fit the unique way you process, reflect, and make meaning.

At the heart of my work is the belief that we are active participants in shaping our inner and outer worlds. We are always moving toward a sense of wholeness and belonging - even when the path feels unclear. I offer feedback, resources, tools, and a steady presence to help you explore your edges, reclaim your voice, and live more fully in your truth.

Most importantly: I believe there is always hope. No matter where you are starting from, I hold the vision that change, healing, and deeper self-understanding are possible for you.

6. Methods I Use in Therapy

I believe there's no single "right" way to heal - different tools work for different people, at different times. Together, we'll choose methods that match your needs, preferences, and goals. Some sessions may be more conversational, while others may involve experiential practices or skill-building.

I integrate a variety of evidence-based and experiential approaches, which may include:

      - Cognitive Behavioral Therapy (CBT)

      - Brainspotting

      - Mindfulness-based practices

      - Yoga, breath work, and neuromuscular exercises

      - Guided meditation and imagery

      - Creative arts interventions

      - Psychoeducation and skills training

My work takes a whole-person, integrative approach - we look at every area of your life, including your physical health, emotional well-being, relationships, environment, and sense of purpose. This allows us to address not just symptoms, but the roots of what you're experiencing, so your healing is deep and sustainable.

7. Therapeutic Touch

If therapeutic touch is ever considered (e.g., hand on shoulder for grounding, hand-hold for support), it will only occur with your explicit consent in the moment. We will create consent-based comfort agreements so you have complete choice in whether any form of supportive, non-sexual touch - including a handshake, hand-hold, or hug - is ever part of your sessions. You may choose to decline touch at any time - and you never need to explain why.

8. Physical Health

Sometimes emotional symptoms have physical causes. I recommend a physical exam before starting therapy - especially if you have headaches, anxiety, depression, or changes in weight - to rule out medical issues. Your physical health can influence your emotional well-being. 

Please inform me of any significant health conditions, medications, or physical limitations that may affect our work together.

9. Electronic Communication & Telehealth

I take your privacy seriously and use only HIPAA-compliant platforms for my end of communication.

      - I offer phone sessions, video sessions, and text-based sessions as part of my therapy services.

      - My phone, text, and video conferencing services are provided through a HIPAA-compliant Health Provider Zoom account.

      - Email and attachments sent through the client portal are also HIPAA-compliant and encrypted.

These safeguards protect confidentiality on my end; however, I cannot guarantee the security of your own devices, email accounts, internet connection, or phone service. Your responsibility: Please use secure networks, keep your devices password-protected, and avoid public or shared devices for therapy-related communication.

Text and Email Use

Text and email are best used for scheduling or canceling appointments. From time to time, I may also share supportive resources such as PDFs, helpful links, or even the occasional lighthearted meme when it feels relevant to your process.

While I'm happy to use these channels for brief check-ins or sharing resources, they are not appropriate for in-depth discussion of therapy content or emergencies. More personal or detailed matters are best saved for our sessions, where we can give them the time and care they deserve.

I aim to respond to messages as promptly as possible but cannot guarantee immediate replies. Messages received outside business hours may be returned the next business day.

Telehealth

     - All telehealth sessions follow the same confidentiality protections as in-person sessions.

     - You may withdraw consent for telehealth at any time without affecting your right to future treatment.

     - No sessions will be recorded without mutual written consent.

     - If there is ever a breach of confidentiality on my end, I will notify you promptly.

Before starting telehealth services, you will be asked to review and sign a separate, detailed Telehealth Consent Form.

10. Scheduling, Attendance, & Absences

Consistency matters in therapy therefore respecting our scheduled time helps keep our work moving forward, but life happens - including illness, emergencies, and travel. I do my best to be flexible while also maintaining our therapeutic rhythm.

Office general hours: Monday-Thursday, 9:00 AM - 7:30 PM. Sessions are by appointment only.

If you are sick: Please stay home if you are ill, have a fever, or are experiencing symptoms of a contagious illness. We can switch to a secure telehealth session instead of meeting in person if you feel well enough to talk.

If I am sick: I will notify you as soon as possible. If I cannot meet in person, I will offer a telehealth session or reschedule.

Late arrival: Please let me know if you will be late. Without notice, I will wait 15 minutes before marking the session as missed.

Cancellations: Please give 48 hours' notice when possible. Less than 24 hours' notice will be billed at the full session rate (insurance will not cover this fee).

Vacations and Planned Absences
I will give you at least two weeks' notice for any planned vacations or extended absences. During that time, I will offer options such as scheduling around my absence, meeting before I leave, or providing referrals for coverage if you wish to continue sessions while I am away.

11. Fees & Payment

I believe in being upfront and clear about costs so you know exactly what to expect. Payment is due at the time of your session unless prior arrangements are made. If your balance exceeds $330, sessions will pause until the balance is paid in full.

   - Initial intake: $275

   - Individual counseling: $165 per 50-minute session with extra time billed at $25 per 15 minute intervals

  - Joint/family counseling: $215 per 75 minute session This service is offered as direct pay only. Insurance is not billed for ongoing joint or family counseling.

   - Group psychotherapy: $60 per 90 -minute session

Sliding Scale Policy

I reserve a portion of my practice for clients who need a reduced rate. Sliding scale fees are based on financial need and may range down to 50% of my standard rates. The sliding scale is intended as a temporary support during times of financial strain. Rates are reviewed every 3-6 months (or sooner if your financial situation changes). As your circumstances improve, I ask that you increase your payment towards the standard dee so these spaces remain available for others. If your situation requires a fee lower than 50%, please talk with me -- we may find other options.

Additional services

Letters, documentation, reports, or extended phone consultations with professionals involved in your treatment that  require time outside of session are billed at $35 per 15 minutes. Insurance will not cover these costs.

Payment Agreement & Collections

      - Payment is due at the time of service.

      - If your account balance exceeds $200, sessions will pause until the balance is paid.

      - If payment is not received in a timely manner, accounts may be referred to collections. You will be responsible for any related fees, including attorney or court costs.

12. Insurance

If you choose to use insurance, I'll help you navigate the process as much as possible, though coverage is ultimately your responsibility to confirm.

  - I accept some insurance plans not all; others may be "out of network" (a superbill can be provided for possible reimbursement).

  - You are responsible for verifying coverage and obtaining any required authorizations.

Diagnosis Requirement & Record Review

 - Insurance companies require a mental health diagnosis to authorize and pay for services. This diagnosis becomes part of your medical record.

  - Insurance providers have the right to review or audit your clinical records to determine medical necessity and continued coverage. This may include progress notes, treatment plans, and summaries.

  - Using insurance means your personal health information may be shared with your insurance provider in accordance with HIPAA regulations.

Health vs. Auto Insurance

Health insurance - I bill health insurance directly for covered mental health services when we are in-network, or provide a superbill for out-of-network reimbursement.

Auto insurance - If your counseling is related to a motor vehicle accident or billed through auto insurance, payment is due directly from you at the time of service. This is because auto insurance claims often involve litigation or third-party liability, which can delay or complicate payment. You may submit receipts to your auto insurance for possible reimbursement.

13. Your Records & Privacy 

Your records are kept secure and confidential. They help tract your progress and ensure continuity of care, and you have the right to request access to most of your clinical information.

  - Clinical records are stored in an Electronic Medical Records (EMR) system

  - All records are maintained for 7 years after therapy ends, then securely destroyed

  - Clinical Record: Contains treatment plans, diagnoses, progress notes, and required documentation

  - Psychotherapy Notes: My personal reflections used in treatment, kept separate from your clinical record and are not shared without your written consent.

14. Confidentiality & Limits

Your privacy matters deeply. What you share here stays private, with a few exceptions required by law or ethics. Whenever possible, I will talk with you before sharing information.

Exceptions to confidentiality include:

   - Risk of harm to yourself or others

   - Court orders requiring releases of information

   - Suspected abuse or neglect of a child, elder, or vulnerable adult

   - Your written permission for insurance or other purposes 

15. Risks & Benefits of Counseling

Therapy can be deeply rewarding, but it is also a process of growth - and growth can sometimes feel uncomfortable before it feels better. We may talk about painful memories, explore emotions you've been avoiding, or look closely at patterns that no longer serve you. While these moments can be challenging, they are often important steps toward lasting change.

While most people benefit from therapy, it is important to know that:

Possible Risks

      - You may feel temporary discomfort when discussing difficult memories, experiences, or emotions.

      - Your symptoms maytemporarily worsen before they improve, especially as we begin addressing long-standing patterns or trauma.

      - Therapy can bring changes in relationships. As you grow and make different choices, some relationships may shift, become strained, or even end.

      - You may feel tired, emotionally raw, or unsettled after sessions, particularly in the beginning.

      -- Not all goals are reached quickly - progress may take time, and results vary for each person.

 Possible Benefits

      - Therapy offers the chance for meaningful and lasting positive change:

      - Improved mood, emotional regulation, and coping skills

      - Greater clarity, self-awareness, and sense of purpose

      - Stronger, healthier, and more authentic relationships

      - Increased ability to set boundaries and communicate effectively

      - Reduced symptoms of anxiety, depression, trauma, and stress

      - A deeper sense of wholeness, resilience, and satisfaction in daily life

While I cannot guarantee specific outcomes, I enter each counseling relationship with optimism and the belief that positive change is possible. Even in difficult seasons, I believe there is always hope.

16. Ending Therapy

You have the right to end therapy at any time, and I'll respect your decision. Whenever possible, I suggest having a closing session so we can review your progress and talk about next steps.

I may recommend ending or referring you to another provider if:

  - Therapy is no longer helping

  - Payment is overdue

   - I believe another provider would be a better fit for your needs

17. Consent to Treatment

By signing below, you confirm that:

- You have read and understood the Practice Policies & Informed Consent for Healing Arts Counseling.

 - You have had the opportunity to ask questions and receive clarification about these policies.

 - You understand the potential risks and benefits of counseling, as outlined in this document.

 - You understand that confidentiality has limits as described, and that insurance companies may require access to certain clinical information.

 - You understand the fees, payment policies, cancellation policies, and any conditions related to insurance billing.

- You understand that therapy is voluntary, and you may end treatment at any time.

- You consent to participate in counseling services with Kelly Forrester, MS, LPC, under the terms described in this agreement. 

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. MY PLEDGE REGARDING HEALTH INFORMATION:

I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you, and describe certain obligations I have regarding the use and disclosure of your health information. 

I am required by law to:

- Make sure that protected health information ("PHI") that identifies you is kept private.

- Give you this notice of my legal duties and privacy practices with respect to health information.

- Follow the terms of the notice that is currently in effect.

- I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in my office, and on my website.

II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:

The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures I will explain what I mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways I am permitted to use and disclose information will fall within one of the categories.

For Treatment Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client's personal health information without the patient's written authorization, to carry out the health care provider's own treatment, payment or health care operations. I may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your person health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition.

Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word "treatment" includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another. 

Lawsuits and Disputes: If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

1. Psychotherapy Notes. I do keep "psychotherapy notes" as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:

a. For my use in treating you.

b. For my use in training or supervising mental health practitioners to help them improve

their skills in group, joint, family, or individual counseling or therapy.

c. For my use in defending myself in legal proceedings instituted by you.

d. For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA.

e. Required by law and the use or disclosure is limited to the requirements of such law.

f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.

g. Required by a coroner who is performing duties authorized by law.

h. Required to help avert a serious threat to the health and safety of others.

2. Marketing Purposes. As a psychotherapist, I will not use or disclose your PHI for marketing purposes.

3. Sale of PHI. As a psychotherapist, I will not sell your PHI in the regular course of my business.

IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION. Subject to certain limitations in the law, I can use and disclose your PHI without your Authorization for the following reasons:

1. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.

2. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone's health or safety.

3. For health oversight activities, including audits and investigations.

4. For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain an Authorization from you before doing so.

5. For law enforcement purposes, including reporting crimes occurring on my premises.

6. To coroners or medical examiners, when such individuals are performing duties authorized by law.

7. For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.

8. Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.

9. For workers' compensation purposes. Although my preference is to obtain an Authorization from you, I may provide your PHI in order to comply with workers' compensation laws.

10. Appointment reminders and health related benefits or services. I may use and disclose your PHI to contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that I offer.

V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.

1. Disclosures to family, friends, or others. I may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say "no" if I believe it would affect your health care.

2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.

3. The Right to Choose How I Send PHI to You. You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests.

4. The Right to See and Get Copies of Your PHI. Other than "psychotherapy notes," you have the right to get an electronic or paper copy of your medical record and other information that I have about you. I will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and I may charge a reasonable, cost based fee for doing so.

5. The Right to Get a List of the Disclosures I Have Made.You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost based fee for each additional request.

6. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information. I may say "no" to your request, but I will tell you why in writing within 60 days of receiving your request.

7. The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.

EFFECTIVE DATE OF THIS NOTICE: This notice went into effect on April 7, 2013

Acknowledgement of Receipt of Privacy Notice

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. By checking the box below, you are acknowledging that you have received a copy of HIPAA Notice of Privacy Practices.

BY CLICKING ON THE CHECKBOX BELOW I AM AGREEING THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.

Telehealth technology services will be conducted with HIPAA-compliant video conferencing, phone, and or instant messaging services provided by Counsol, Zoom, or Google Meet. It is simple to use and there are no passwords required to log in. By signing this document, I acknowledge the following:

By signing this form, I certify:

I have read and understand the information provided above, have discussed it with my therapist, and understand that I have the right to have all my questions regarding this information answered to my satisfaction.

You are welcome to pay for sessions with cash, check, HSA/FSA card, or credit card at the time of service or according to a mutually agreed upon payment plan.

In the event that you prefer to be automatically charged (autopay) or have an outstanding balance, this agreement authorizes Kelly Forrester, M.S., LPC of Healing Arts Counseling LLC to charge your credit card on file. Note: Your information is safely stored within Counsol servers using bank-level encryption.

Your credit card may be billed under the following circumstances:

~ To pay for a scheduled in-office or telehealth session;

~ To pay for any outstanding balance on your account;

~ To pay for any charges that your insurance does not cover;

~ Failure to make payments on a previously agreed upon payment plan;

~ To pay for a missed session (without notice/no-show) within 7 business days;

~ To pay a late cancellation fee for a session that was canceled less than 24 hours from the scheduled start of the session within 7 business days;

~ To cover a returned check: Amount of check + bank charges for each returned check; To cover chargeback fees: Original amount + chargeback fee.

Please be advised that any of the above services will be charged to the card you have on file. If this card is an HSA/FSA/HRA card, certain non-session charges may not be allowed. You may keep a second card on file for these charges if you choose. It is your responsibility to utilize your HSA/FSA/HRA card in accordance with the plan rules and you are responsible for any back taxes, penalties, or other charges or fees when using this card.

Outstanding balances, not including those with an agreed-upon payment plan, will be run through on the 15th and 30th of each month.

Statement of Understanding

I understand that I am fully responsible for all scheduled and attended sessions. If any of the above circumstances apply, Kelly Forrester, M.S., LPC of Healing Arts Counseling LLC has my permission to charge my card(s) on file accordingly. I attest that I am the owner of the card(s) on file and that I understand the card use policies, rules, and limitations. I understand that it is my duty to keep my card information current. I further understand that if I am having difficulty paying I can speak with my therapist about alternative arrangements. I understand that I may view this policy at any time by signing into the Client Portal or by requesting a copy.