(330) 921-8308 | pathways.ohio.therapy@gmail.com

Pathways of Ohio Counseling Services, LLC

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Client Forms

Pathways of Ohio Counseling Services uses TherapyNotes to create and store our client data and clinical notes.  TherapyNotes is a highly rated, HIPAA compliant Electronic Medical Records (EMR) system that allows us to expediate the therapy intake process by using the system’s Patient Portal.

When you call our office to set up your first appointment, our administrative staff will give you instructions on how to access the Portal.   Through the Portal, you will complete forms that securely store your demographic data, insurance and other information.  As an active client you’ll also have permanent access to Pathways’ policies and procedures listed below.

IMPORTANT INFORMATION FOR CLIENTS WHO PLAN TO PAY CASH FOR THEIR PSYCHOTHERPAY SERVICES OR THOSE WHO HAVE INSURANCE, BUT DO NOT WISH TO USE THEIR INSURANCE BENEFITS AND TO PAY FOR THEIR THERAPY SERVICES IN CASH!

As of January 1, 2022, Federal law, H.R. 3630, also known as “The No Surprises Act” requires medical providers to present their patients who are paying cash for their medical treatment to receive a Good Faith Estimate (GFE) of what the charges could be for the psychotherapy services that are provided to you by Pathways of Ohio Counseling Services, LLC, (Pathways) and its contracted providers. While it is not possible for your psychotherapist to know in advance how many psychotherapy sessions may be necessary or appropriate for a given person, this form provides an estimate of the cost of the services that could be provided to you over the next 12 months.  The bill also defines a dispute resolution process should our charges be higher than our estimated costs in the GFE.

For questions or more information about your right to a Good Faith Estimate or the dispute resolution process, visit https://www.cms.gov/nosurprises/consumers or call 1- 800-985-3059.  You can also call the Pathways administrative office for more information.

Because the GFE is based the service start date of each new client and must be provided to the new client three days before the start of Pathways’ services, it is unique to each new client and as such, you will not find the GFE in the forms listed below.

 

Therapy Notes Portal Instructions

Pathways Operations and Procedures

The Consent Document

Agreement to Contact

Assignment of Benefits

Notice of Privacy Practices

Financial Obligations

Clients Rights and Responsibilities

Social Media and Communications Policies

Insurance Charges

Fee for Service Cash Pay Rates

Non Clinical Fees

Adult Client Services Contract

Client Rights

Communication Guidelines

HIPAA Law

Receipt of PW Policies and Procedures

Client Portal and Email Permission

 Agreement to Contact

CPT Fee Schedule

Cash Pay Fee Schedule

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Pathways of Ohio Counseling Services, LLC

(330) 921-8308

pathways.ohio.therapy@gmail.com

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(330) 921-8308
pathways.ohio.therapy@gmail.com

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