Statement of Disclosure

Cate DiMarzio, LLC P.A.

Cate DiMarzio, LCPC
Licensed Clinical Professional Counselor
60 Forest Falls Drive, Suite 7
Yarmouth, ME 04096
(207) 846-1008 ● catedlcpc@gmail.com

Please download and sign
a copy of this disclosure statement
and bring it with you to our first meeting

As part of my licensure requirements with the state of Maine, I am mandated to provide this disclosure statement to all clients. I also believe it is helpful to discuss our mutual expectations.

I hold an M.S. degree in Clinical Counseling. I am licensed by the State of Maine as a Clinical Professional Counselor. My license # CC 1966 was originally issued on July 26, 1999; my current license was issued on May 3, 2017 and expires on June 30, 2019.

I am trained to work with adults, children, families and groups, and at one point or another in my career I have done all of these things. I work from a “client-centered” perspective, meaning I will assist you in reaching the therapeutic goals important to you. Growth and change can sometimes be difficult and painful, and at other times, gratifying and exhilarating. I hope together we can make your experience meaningful and enriching. I am trained in a number of therapeutic theories and modalities, and I have woven these into an eclectic style that works for many clients. However if what we are doing is not feeling helpful to you, please let me know because these sessions belong to you. I am trained to do EMDR (Eye Movement and Desensitization Reprocessing), DBT (Dialectical Behavior Therapy) and a specific type of Emotion Regulation based in the neuroscience of the Autonomic Nervous System. I incorporate mindfulness, Non-Violent Communication, and sometimes, writing and artwork into sessions. From time to time, I may assign homework. I don’t give demerits if homework is not completed, but working on things outside of session can streamline treatment.

In the first few meetings I gather information about presenting issues, family configuration and history, and general background information, including medical, psychiatric, and substance abuse history, work and educational experience; and religious or spiritual background and beliefs. Treatment goals will be mutually agreed upon.

I am happy to entertain questions about our work because I don’t want anything we do to feel mysterious. Please share any questions, concerns, or dissatisfactions you have so we can work together to resolve them to your satisfaction. You are free to terminate counseling whenever you wish. However, it is beneficial to give a couple of week’s notice, so we can plan our ending and have an appropriate sense of closure.

What you say to me in our sessions is confidential and will not be shared by me with anyone, except in the following circumstances:

• If there is a threat of serious harm to self or others;
• If there is a suspicion of child abuse or abuse of elder or any incapacitated person;
• If there is a court order to release records
• If there is a voluntary release signed by client or guardian;
• In defense against any legal action or formal complaint which client makes before a court or regulatory board;
• During supervisory consultations in a peer group or in individual supervision I may anonymously discuss your case. These professionals are bound to these same confidentiality rules.
• Information may be released to your insurance company as they require.
• Insurance and billing related information will be handled by my employed or contracted billing service providers, all of whom are also bound to confidentiality.

I bill the insurance company $125 for a one hour session. For companies with whom I have a contract, I accept their maximum allowed. Some insurance policies allow benefits for out-of-network providers. If I am not a provider for your insurance company, please check your policy to see if you have out-of-network benefits. For clients with a deductible, the insurance company dictates the amount charged to your deductible, which is payable to me by the client. I expect co-pay and deductible amounts to be paid at the time of service. I accept checks (made payable to Cate DiMarzio, LLC P.A.), Cash, and HSA, Debit, and Credit Cards. For checks returned to me for any reason, bank charges are passed onto the client. I reserve the right to work with a collection agency to recover any funds overdue for 90 days and to pass along any collection fees to the client.

Twenty four hour notice is required when canceling an appointment. For clients who miss a scheduled appointment without providing 24 hour notice, the full fee will be assessed. On snow days I leave it up to clients whether or not they feel safe driving,. If I take a snow day, I will notify you first thing in the morning, and leave an outgoing voice mail, so you can call to check. And if I am ill, I will notify early in the day.

You may reach me at the phone number on this disclosure. Confidential voicemail is available 24 hours, and calls will be returned as soon as possible, usually within 24 hours. I am in this office Monday through Thursday and return phone calls on those days. If you are in crisis and unable to wait for a call back, contact your family physician, call for crisis services at 1-888-568-1112, or go to your local emergency room.

I am willing to text or email about scheduling issues. Although my phone and email are password protected, neither is encrypted and therefore, not HIAA compliant. I cannot guarantee the safety of information sent to me via text or email and prefer not to discuss clinical issues in these venues. However, if you text me about a clinical issue, I will consider you have willingly waived your right to privacy and will answer in kind.

I assure you that my services will be rendered in a professional manner consistent with acceptable ethical practices. While I am unable to guarantee any specific results regarding your counseling goals, we will work together to achieve the best possible results for you. Again, I encourage and welcome discussion with you if I offend you in any way. I work hard to provide you with an open and safe place to share anything that is on your mind. If issues come up between us an honest discussion on both our parts can go a long way to repair any ruptures in the therapeutic relationship, as well as provide a safe place for you to use your assertiveness skills. Concerns and complaints unresolved to your satisfaction may be filed with the Licensing Board, Department of Professional and Financial Regulation, Division of Licensing and Enforcement, State House Station #35, Augusta, ME 04333; (207) 624-8626; Fax: (207) 624-8637. You also have the right to examine public records maintained by the Maine Board of Counseling Professional Licensure containing counselor credentials and to obtain a copy of the Code of Ethics.

A copy of the HIPAA Regulations was offered as a part of this Disclosure Statement.