Crafting Balance provides clinical psychotherapy services in accordance with applicable federal and state laws, including HIPAA. Your privacy rights, clinical care, and treatment decisions are governed by your treating clinician and, where applicable, supervising and billing provider(s) at the time of intake, consistent with licensure requirements, payer rules, and Crafting Balance clinical policies.

Administrative or operational matters—such as billing systems, internal management, or organizational structure—do not alter:

•the confidentiality of your protected health information (PHI),

•your right to privacy,

•or your continuity of care.

All PHI and clinical documentation are accessed only by individuals directly involved in your treatment, supervision, or authorized billing functions, as permitted by law. Any administrative updates are handled in a manner that maintains compliance with HIPAA and does not affect your relationship with your clinician or the care you receive.

Your appointment time is reserved exclusively for you. For this reason, we ask that all cancellations or rescheduling requests be made at least 24 hours in advance. Appointments canceled with less than 24 hours’ notice, or appointments missed entirely (no show), result in a $200 cancellation fee, which is not covered by insurance. To maintain privacy and the therapeutic environment, all sessions—whether in person or via telehealth—must occur in a quiet, private location free from distractions. If the environment is not clinically appropriate, your clinician may end the session. In such cases, the appointment will be counted as a late cancellation and the cancellation fee will apply.

For all clients, a current and valid payment method must remain on file. By beginning services, you authorize Crafting Balance to process charges for session fees, cancellation fees, returned payment fees, and any additional applicable charges. If a valid charge is disputed, a separate processing fee may be added. Appointment reminders sent by the system are a courtesy. Even if a reminder is not received, the responsibility to attend or cancel appointments on time still rests with the client. Standard individual sessions last approximately 53 minutes, unless a different length has been arranged in advance. Insurance coverage varies by plan. If your insurance denies payment for any reason—including deductible, inactive policy, or billing errors—you will be responsible for the full cost of the session at the standard rate. Returned checks or rejected payments incur an administrative fee. Outstanding balances are subject to collection services.

90791 Diagnostic Evaluation (60 min): $250

90837 Individual Psychotherapy (55 min): $190

90834 Individual Psychotherapy (45 min): $190

90839 Psychotherapy for Crisis (50 min): $300

90840 Crisis Add-On (each 30 min): $200

Family & Group Therapy

90846 Family Therapy (without patient): $275

90847 Family Therapy (with patient): $275

90853 Group Therapy (50 min): $140 per person

Documentation & Forms

Documentation/form preparation (per 30 min): $175

Sliding scale rates are a courtesy extended to uninsured and underinsured clients upon request and are not guaranteed. These reduced rates are not indefinite and may be adjusted with notice. Sliding scale eligibility may be reviewed and reconsidered every 90 days based on clinical, financial, or operational factors. The discounted sliding scale rate applies only to therapy sessions. It does not apply to late cancellations, no-shows, or other fees. If a client receiving a sliding scale rate misses an appointment or cancels with less than 24 hours’ notice, the full $200 cancellation fee will apply.

You may contact your clinician in the secure client portal for non-urgent matters. Messages are generally returned within one business day. Because voicemail, text, or email is not intended for emergencies, you should call 911, go to the nearest emergency room, or contact the 988 Suicide & Crisis Lifeline if you are experiencing a crisis or safety concern.

I understand that all telehealth sessions must take place while I am physically located within a state where my clinician is licensed to practice. I agree to accurately disclose my physical location at the start of each telehealth session and to notify my clinician in advance if I will be traveling or located outside the:

• State of Maryland

• State of Washington DC

• State of North Carolina

I acknowledge that providing inaccurate, incomplete, or false information about my physical location during a telehealth session may limit my clinician’s ability to provide safe, legal, and effective care. By signing below, I release my clinical team, consisting of my treating, supervising, and/or billing providers, Crafting Balance, and all affiliated or authorized Crafting Balance brands and entities from any liability arising from my failure to accurately disclose my physical location or from my participation in a telehealth session outside of an approved jurisdiction.

You may contact your clinician in the secure client portal for non-urgent matters. Messages are generally returned within one business day. Because voicemail, text, or email is not intended for emergencies, you should call 911, go to the nearest emergency room, or contact the 988 Suicide & Crisis Lifeline if you are experiencing a crisis or safety concern.

To protect your confidentiality and to maintain the integrity of the therapeutic relationship, clinicians cannot accept friend requests or engage with clients through social media platforms. This includes following client accounts, responding to direct messages, or engaging with posts. These boundaries are standard in psychotherapy and are intended to preserve your privacy.

Email and text messaging may be used only for brief, administrative purposes such as scheduling, rescheduling, or confirming appointments. These communication methods are not secure and should not be used for clinical discussions, urgent matters, or emergencies. Your clinician may not respond immediately, and confidentiality cannot be guaranteed when using electronic communication. Please utilize the secure client portal to ensure the protection of sensitive information.

Parents or legal guardians may be legally entitled to certain information about a minor’s treatment. Building a therapeutic relationship with any client, particularly a minor, is essential. And such, your clinician will discuss confidentiality limits with you and your family at the beginning of treatment so as not to break the therapeutic rapport-building process. When a parent or guardian places a payment method on file, they accept full responsibility for the cost of all services and outstanding charges incurred by the minor.

Ending therapy is a meaningful process. Treatment may conclude when therapeutic goals have been met, when therapy is no longer clinically appropriate, or if participation becomes inconsistent. If you have not attended an appointment for three consecutive weeks without prior arrangement, services may be considered discontinued for clinical and ethical reasons. Outstanding balances or repeated missed appointments may also result in the termination of services. Referrals to other clinicians or services will be provided as needed.

Crafting Balance is committed to protecting your personal health information in accordance with the Health Insurance Portability and Accountability Act (HIPAA), applicable Maryland, Washington DC and North Carolina law, and professional ethical standards. Your data is used only for purposes related to treatment, payment, and healthcare operations, unless you provide specific written authorization for additional disclosures as required by law. You have the right to request access to your records, request amendments, and receive an accounting of disclosures in accordance with HIPAA and Maryland law. Reasonable fees may apply for record preparation or copying, as permitted by law.

• I CONFIRM RESIDENCE IN THE STATE OF MARYLAND

• I CONFIRM RESIDENCE IN THE STATE OF WASHINGTON DC

• I CONFIRM RESIDENCE IN THE STATE OF NORTH CAROLINA

By signing below, I confirm that I have received and reviewed the Crafting Balance’s Practice Policies & Procedures. I understand that these policies describe how appointments, billing, communication, telehealth, confidentiality, and treatment procedures are managed. I understand that Crafting Balance may update these policies as needed to remain legally and ethically compliant and that the most current version will always be available at https://www.craftingbalancellc.consulting. I acknowledge that it is my responsibility to review these updates and that continuing to participate in services means I agree to the most current version. I also understand that telehealth sessions require me to be physically located in Maryland unless my clinician is licensed in the state where I am located, and I agree to accurately report my location for all remote sessions. By signing, I agree to abide by these policies and to receive services under these terms. I have read, understand, and agree to the terms described in the above section and to this document in its entirety. I confirm that I fully accept these policies and consent to receiving services under these conditions. I understand that I have the right to ask questions, decline to sign, or discontinue services at any time. By signing below, I acknowledge that I voluntarily agree to all terms of Crafting Balance’s Practice Policies & Procedures and all other signed consents for treatment, without exception, unless otherwise explicitly agreed upon in writing.