Dr. Rosa L. Thomas, Ph.D., PSY 20906

369B 3rd Street Box 117

San Rafael, CA 94901



APPOINTMENTS AND CANCELLATIONS Appointments tend to be made by direct agreement between us. However, I may open a calendar through my client portal for ease of access in scheduling. The frequency of therapeutic appointments will be discussed as part of your treatment plan. In general, therapy sessions should occur weekly or no less than biweekly. Maintenance or supportive care may be less frequent. Please remember to cancel or reschedule 48 hours in advance. You will be responsible for my usual and customary fee if cancellation is less than 48 hours.

The standard meeting time for psychotherapy is 45 minutes. It is up to you, however, to determine the length of time of your sessions. Requests to change the 45-minute session need to be discussed with the therapist in order for time to be scheduled in advance.

My usual and customary fee for service is $250 per clinical hour. In certain cases, a different fee may be arranged by mutual agreement, whether due to hardship in the case of a lower fee or due to specialty services, e.g., forensic, testing, or out-of-office expenses or services, in the case of higher fees. Changes in the fee agreement will be documented as part of your record.

Payments accepted include cash, bank draft, and electronic payment processing services. Credit card payments are not currently available. Please note that your confidentiality cannot be fully assured other than for cash payments. Not all services can provide a Business Associates Agreement (BAA) for handling your payment. I will endeavor to obtain a BAA for payment processing services but cannot assure that every company will agree. A form of payment will be requested at the time of intake which may be used for session payments and for late cancellations. If you prefer, a cash amount can be held in escrow. A $10.00 service charge will be charged for any checks returned for any reason for special handling.

Cancellations and re-scheduled sessions will be subject to a full charge of $250.00 if NOT RECEIVED AT LEAST 48 HOURS IN ADVANCE. This is necessary because a time commitment is made to you and is held exclusively for you, and open hours are offered at my usual and customary fee. If you are late for a session, you may lose some of that session time. Please note that your insurance company may not reimburse you for missed appointments.

TELEPHONE ACCESSIBILITY If you need to contact me between sessions, please leave a message on my voice mail. I am often not immediately available; however, I will attempt to return your call within 24 hours except for weekends and holidays and scheduled time out of the office. Please note that face-to-face sessions are highly preferable to phone sessions, nor will I provide therapy exclusively by phone. However, in the event that you are out of town, sick, or need additional support, phone sessions may be available.

ELECTRONIC COMMUNICATION In order to maintain clarity regarding our use of electronic modes of communication during your treatment, I have prepared the following policy. This is because the use of various types of electronic communications is common in our society, and many individuals believe this is the preferred method of communication with others, whether their relationships are social or professional. Many of these common modes of communication, however, put your privacy at risk and can be inconsistent with the law and with the standards of my profession. I cannot ensure the confidentiality of any form of communication through electronic media. Consequently, this policy has been prepared to assure the security and confidentiality of your treatment and to assure that it is consistent with ethics and the law.

If you have any questions about this policy, please feel free to discuss this with me.

Email And Text I use email communication and text messaging only with your permission and only for administrative purposes unless we have made another agreement. That means that email exchanges and text messages with my office should be limited. While I may try to return messages in a timely manner, I cannot guarantee an immediate response. Please do not email or text me about clinical matters because this is not a secure way to contact me. If you need to discuss a clinical matter with me, please feel free to call me so we can discuss it on the phone or wait so we can discuss it during your therapy session. The telephone or face-to-face context simply is much more secure as a mode of communication.

Email and text messaging should not be used to communicate with me in an emergency. I make every effort to respond to emails, texts, and phone calls within 24 hours, except on weekends and holidays. In case of an emergency, please call my phone line at 415-497-5101. If I am not immediately available by phone, please call 911, or contact local crisis services at 415-781-0500, or 800-273-8255 (National Suicide Prevention hotline), or text MYLIFE to 741741, or go to the nearest emergency room.

Social Media I do not communicate with, or contact, any of my clients through social media platforms like Twitter and Facebook. In addition, if I discover that I have accidentally established an online relationship with you, I will cancel that relationship. This is because these types of casual social contacts can create significant privacy risks for you.

I have an Instagram account for my professional activities. I otherwise participate on various social networks, but not in my professional capacity. If you have an online presence, there is a possibility that you may encounter me by accident. If that occurs, please discuss it with me during our time together. I believe that any communications with clients online have a high potential to compromise the professional relationship. In addition, please do not try to contact me in this way. I will not respond and will terminate any online contact no matter how accidental.

Websites I have a website that you are free to access at rosathomasphd.com. I use it for professional reasons to provide information to others about me and my practice. You are welcome to access and review the information that I have on my website and, if you have questions about it, we should discuss this during your therapy sessions.

Web Searches I will not use web searches to gather information about you without your permission. I believe that this violates your privacy rights; however, I understand that you might choose to gather information about me in this way. In this day and age, there is an incredible amount of information available about individuals on the internet, much of which may actually be known to that person and some of which may be inaccurate or unknown. If you encounter any information about me through web searches, or in any other fashion for that matter, please discuss this with me during our time together so that we can deal with it and its potential impact on your treatment.

Recently it has become common for clients to review their health care provider on various websites. However, mental health professionals cannot respond to such comments because of confidentiality restrictions. It is also generally preferable for clients to discuss their concerns directly with their health care provider. If you have concerns or questions about any aspect of our work together or about any previously posted online reviews of my practice, please let me know so that we can discuss them. I recommend that you do not rate my work with you on any website for several reasons. If you rate my work on a website while you are in treatment with me, it has the potential to affect our therapeutic relationship. If you choose to post an online review about me or another health care provider either while you are in treatment or afterward, please keep in mind that you may be revealing confidential information about your treatment.

Thank you for keeping this policy in mind and for letting me know of any concerns.

General Information for Electronic Communication Services by electronic means, including but not limited to telephone communication, the Internet, facsimile machines, and e-mail is considered telemedicine by the State of California. Under the California Telemedicine Act of 1996, telemedicine is broadly defined as the use of information technology to deliver medical services and information from one location to another. If you and your therapist chose to use information technology for some or all of your treatment, you need to understand that: (1) You retain the option to withhold or withdraw consent at any time without affecting the right to future care or treatment or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled. (2) All existing confidentiality protections are equally applicable. (3) Your access to all medical information transmitted during a telemedicine consultation is guaranteed, and copies of this information are available for a reasonable fee. (4) Dissemination of any of your identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without your consent. (5) There are potential risks, consequences, and benefits of telemedicine. Potential benefits include, but are not limited to improved communication capabilities, providing convenient access to up-to-date information, consultations, support, reduced costs, improved quality, change in the conditions of practice, improved access to therapy, better continuity of care, and reduction of lost work time and travel costs. Effective therapy is often facilitated when the therapist gathers within a session or a series of sessions, a multitude of observations, information, and experiences about the client. Therapists may make clinical assessments, diagnosis, and interventions based not only on direct verbal or auditory communications, written reports, and third-person consultations, but also from direct visual and olfactory observations, information, and experiences. When using information technology in therapy services, potential risks include, but are not limited to the therapist’s inability to make visual and olfactory observations of clinically or therapeutically potentially relevant issues such as: your physical condition including deformities, apparent height and weight, body type, attractiveness relative to social and cultural norms or standards, gait and motor coordination, posture, work speed, any noteworthy mannerism or gestures, physical or medical conditions including bruises or injuries, basic grooming and hygiene including appropriateness of dress, eye contact (including any changes in the previously listed issues), sex, chronological and apparent age, ethnicity, facial and body language, and congruence of language and facial or bodily expression. Potential consequences thus include the therapist not being aware of what he or she would consider important information, that you may not recognize as significant to present verbally to the therapist.

TERMINATION Closing the therapeutic relationship is part of the ordinary course of psychotherapy. Closure can be difficult, but a process for terminating our work is important to healthy outcomes in psychotherapy. The appropriate length of the termination depends on the length and intensity of the treatment. If I determine that the psychotherapy is not being effectively used, I may terminate treatment after appropriate discussion with you and a termination process. Similarly, I may terminate after appropriate discussion with you if you are in default on payment. I will not end the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. If therapy is terminated for any reason or you request another therapist, I will endeavor to provide you with a list of qualified psychotherapists to treat you. You may, of course, also choose someone on your own or from another referral source.

Should you fail to schedule an appointment for three consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, I must consider the professional relationship discontinued.