Professional Disclosure Statement

More commonly known as informed consent, this document is required by the NC Board of Licensed Clinical Mental Health Counselors. If you become a client, it will be part of your intake paperwork and will remain on file in TherapyPortal.

Professional Disclosure Statement

Kayce Hodos, M.Ed., LCMHC, NCC, PMH-C

833 Wake Forest Business Park Wake Forest, NC 27587

919.414.0979 Fax: 919.578.8766 hello@kaycehodos.com

Education, Credentials, and Professional Activities

Services Offered

My educational training and professional experience have prepared me to provide counseling for a variety of issues, including, but not limited to, loss and grief, adjustment challenges, anxiety, and depression. I have specialized training and experience in treating Perinatal Mood and Anxiety Disorders (PMAD) and am certified in Perinatal Mental Health (PMH-C) through Postpartum Support International. I have been working as a professional counselor since 2004 and in private practice since 2007. You will find that my clinical approach involves a blend of cognitive-behavioral therapy (CBT) and mindfulness techniques built upon a person-centered foundation. A strong therapeutic relationship requires a safe environment where clients can express themselves and feel valued and heard. I currently serve adults ages 18 and over.

Services and fees:

Initial intake session (50 minutes) - $225

Follow-up session (50 minutes) - $225

Follow-up session (90 minutes) - $340

Walk + Talk session (50 minutes) - $250

No shows and cancellations with less than 24 hours notice will result in a charge of the full fee for the scheduled service.

Payment by credit card is processed via TherapyPortal at time of service.

I am not in-network with any insurance plans. If you are interested in using your out-of-network healthcare benefits, please be aware that I am required to diagnose you with a mental illness and document this information in your permanent file. I will provide a SuperBill with the necessary information for you to file with your carrier. It is important that you contact your insurance company to find out your reimbursement rate for an office visit with an out-of-network therapist (codes 90791 and 90837). Walk + Talk therapy is not typically covered by insurance.

Confidentiality and Limitations

In accordance with state and federal laws and my professional and ethical standards, any information you share is kept strictly confidential with the following exceptions:

  • Threat of serious harm to self or others

  • Reasonable suspicion of abuse of a child or elderly person

  • Court order

Complaints

I abide by the ACA Code of Ethics (https://ncblcmhc.org/Assets/LawsAndCodes/ACA_Code_of_Ethics(2014).pdf). Although you are encouraged to discuss any concerns with me directly, you may file a complaint with the North Carolina Board of Licensed Clinical Mental Health Counselors if you feel I am in violation of any of these guidelines:

North Carolina Board of Licensed Clinical Mental Health Counselors

P.O. Box 77819 Greensboro, NC 27417

Phone: 844-622-3572 or 336-217-6007 Fax: 336-217-9450

E-mail: complaints@ncblcmhc.org

www.ncblcmhc.org