DISCLOSURE STATEMENT
CherylAnn Crego MA, NCC, LMHC
Adagio Wellness PLLC
100 N HOWARD ST STE W
Spokane, WA 99201
www.adagiowellnes.net
cherylann@adagiowellness.net
509-517-7188

Independent Practice

I am an independently contracted provider. All services you receive from me reflect my own health care license, independent business, and practice style.

My License(s), Education and Training

I hold the following license(s) in the indicated state(s): Washington State, LH 61526273.

I received my master’s degree in Clinical Mental Health Counseling at Southern New Hampshire University. I am a member of the American Counseling Association and the Washington Mental Health Counselors Association and am bound by both the ACA Code of Ethics and AMHCA Code of Ethics. I am also a National Certified Counselor per the National Board for Certified Counselors. As a licensed clinician, I am required to participate in continuing education.

Additional information about my licensure is available at https://doh.wa.gov/.

Patient Mix

I offer therapy services for individuals. I see clients age 9 to adult. I do not offer case management services, which includes but is not limited to providing paperwork for disability, unemployment, custody, adoption, foster care, car accidents and any type of legal issues. I do offer therapy for individuals who are court mandated for treatment or seeking treatment in which disclosure of appointments will need to be provided to an outside entity.

Treatment Modality and Therapeutic Orientation

I use a differentiated approach that is based in person-centered theory with relational-cultural and solution-focused therapies, as well as elements of cognitive behavioral and dialectical behavioral therapies.

Therapy has both benefits and risks. During the course of therapy, you might notice changes in your symptoms, problems, and functioning. Since we will be exploring challenging territory in your life, you might experience greater difficulty throughout our work. Therapy typically produces benefits over time, but sometimes as you get to the root of tender issues, you may feel them even more acutely than in the past. I cannot offer any promise or guarantee about the results you will experience. However, as you commit yourself to work through your vulnerable issues and build upon your strengths, it is likely that you will see improvements throughout our work and in the future.

New Patients

There will be 1-2 initial visits to ensure proper assessment and thorough evaluation. Appointment(s) are 50 minutes. These appointments will be used to evaluate, educate and determine a mental health diagnosis. I may want to see you weekly until either your symptoms are alleviated, or your condition is stabilizing. We will work together to determine the best frequency of appointments going forward based on your health, treatment goals and stability of your condition.

Cancelling Appointments

In order to provide you with optimal care, your appointment time is reserved specifically for you. I do not double book clients. In return, I ask that you provide me with a minimum of 24 hours’ notice if you are unable to make it to your appointment. Please email cherylann@adagiowellness.net.

I work with all my clients on a reoccurring, weekly basis. If you cancel several appointments, I will ask that you be removed from your recurring appointment slot and be placed on my on-call list, as repeated cancellations present a barrier to the therapeutic process. If you are on the on-call list, I will reach out to you as appointments become available. If you have repeated no-show appointments, upcoming scheduled appointments may be cancelled.

Requests for Consultation

If you need a consultation outside of a scheduled appointment, please direct your request to me via the email listed.

In general, my office hours are Tuesdays through Thursdays from 9 AM to 3 PM. I may not be able to respond to requests for consultation outside of these hours.

Emergencies

I am not available on an emergency basis. If you are experiencing an emergency or are concerned you may be a threat to yourself or others, please dial 911, 988 (an emergency line specific to suicide and mental health crises) or go to the nearest hospital emergency room.

Contact for Administrative/Scheduling Questions

If you have questions about scheduling, billing, or technology, please contact me at:

cherylann@adagiowellness.net

Rescheduling Appointments

I will make every effort to provide you with adequate notice if I will be unavailable for a scheduled appointment.

If you need to reschedule an appointment, the rescheduling request should be made via email to cherylann@adagiowellness.net. If you need to reschedule an appointment, I ask that you give me at least 24 hours notice in advance of the originally scheduled appointment. Rescheduling requests made without 24 hours advance notice will incur late cancellation fees (see Financial Responsibility section below).

Confidentiality

All information disclosed within appointments is confidential. I keep brief notes of our appointments but such notes and other information related to these appointments will not be disclosed to anyone except as permitted or required by law.

Notice of Privacy Practices

The Adagio Wellness PLLC Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information.

Your Rights

You have the following rights:

-       To refuse treatment;

-       To choose a practitioner and treatment modality which best suits your needs;

-       To expect that I have met the qualifications of training and experience required by state law;

-       To examine public records maintained by the state authority that licenses me and to have such authority confirm my credentials;

-       To obtain a copy of the code of ethics to which I am bound;

-       To report complaints to the state authority that licenses me: https://doh.wa.gov/licenses-permits-and-certificates/file-complaint-about-provider-or-facility/health-professions-complaint-process;

-       To be informed of the cost of my services before receiving the services;

-       To be assured of privacy and confidentiality while receiving services from me (note - the law sometimes permits or requires disclosures of private/confidential information); and

-       To be free from free from discrimination because of age, color, culture, disability, ethnicity, national origin, gender, race, religion, sexual orientation, marital status, or socioeconomic status.

Financial Responsibility

Private Pay (Cash Pay) Fees

·      $150 per 50-minute session for individuals

Cancellation Fees

If you are unable to provide more than 24 hours’ notice, you will incur a missed appointment/late cancellation fee as follows:

·      $150 for missing session

This charge is irrespective of the reason for the cancellation/no show. Insurance does NOT cover this fee and will automatically be charged to the credit card listed on file.

While I understand unexpected things sometimes pop up, if there is a pattern noticed of cancelled appointments, I may be unable to continue providing services to you, and I reserve the right to cancel future appointments in order to make room for clients committed to the therapeutic process. I will always communicate about this with you and determine if we’re a good fit prior to making changes to your scheduled appointments.

Collections

If you have an unpaid patient balance of $100 for more than 120 days, the balance may be turned over to a third-party collections agency. You will receive a final courtesy phone call and/or letter to remind you of your balance due. If you believe that there is an error in your billing, please let us know as soon as possible so we can research the issue. Unpaid balances without a payment plan or partial payment initiated after 120 days will initiate a phone collections effort for recovery, and some identifying confidential information will be released in this process. This may negatively impact your credit. It is very important that you update your contact information with us to ensure you are aware of your financial responsibility and receive your statements.