INITIAL CONSULTATION NOTICE

• You are scheduled for an initial consultation with Dulcinea Pitagora LCSW PLLC (referred to as the “Practice”) for clinical services.

• During this consultation, we will discuss your reasons for seeking treatment and review your health history. This meeting is our first opportunity to determine whether working together is a good fit.

• Please note that an initial consultation does not guarantee that the Practice will provide treatment. If we mutually decide to move forward with treatment, we will move forward with establishing care and provide you with additional documents outlining our services, policies, and your rights.

• There is no fee for the initial consultation. We will discuss the fees for our ongoing services during the meeting.

• This practice does not provide emergency services. In the event of a psychiatric emergency, call 988 or 911, or go to the nearest emergency room.

• We may maintain records of our initial clinical interactions with you, including health information you disclose during this consultation.

• When it comes to your health information, you have rights. More information can be found in the Practice’s Notice of Privacy Practices found at www.dulcineapitagora.com/privacy-policy.

• We may communicate by email or videoconference, and we will store records electronically. Electronic communication and data storage involve certain risks, including the possibility that unauthorized third parties may access emails, text messages, videoconference sessions, or our records and notes. Do not send private health information by email. You may request alternative communication methods that feel more comfortable to you and we will consider reasonable requests.