The Board of Mental Health Practice regulations, including the Mental Health Bill of Rights, require all licensed mental health professionals to provide clients with certain basic information. I am also providing additional information about my practice for your review and agreement. Please read it carefully and let me know if you have any questions or concerns. You will be asked to sign this agreement prior to the start of our work together.

1.  License and Code of Ethics

   I am a licensed psychologist, governed by the Code of Ethics of the American Psychological Association. My license is in the state of New Hampshire. The code of ethics is available here. I will provide information about my training, qualifications, and experience at our initial meeting, and it is available upon request at any time.

2.   Qualifications and Scope of Practice

   I received my Doctorate in Clinical Psychology in 2019 from Nova Southeastern University. My practice includes the treatment of anxiety, depression, post-traumatic stress disorder, insomnia, chronic pain, eating and body concerns. I received clinical training in general mental health concerns and health psychology at the Nova Southeastern University OCD and Related Disorders (NORD) Clinic, Florida Atlantic University CAPS, West Palm Beach VA Healthcare System, Dartmouth College Counseling Center, and the White River Junction VA Healthcare System.

3. I am an integrative therapist and provide therapeutic services tailored to the unique needs of each client. I am trained as a cognitive-behavioral therapist and often integrate acceptance and commitment therapy and internal family systems therapy into my practice. Therapy requires clients to be active, both during and between sessions, for maximum benefit. You will be asked to consider new perspectives and practice new behaviors. Please note that successful psychotherapy involves a commitment of time, energy, money, and a willingness to implement interventions under the guidance of your therapist. I encourage you to approach therapy with a “beginner’s mind” - open, curious, self-compassionate, patient, and persistent.

   During the initial session(s), I will be getting to know you and evaluating your needs. If I feel that you would be better served by someone else, I will discuss this with you either during the initial session (if it is apparent at that time), or during a feedback session. If you do not feel I am a good fit for your needs, please let me know. I am happy to help you identify an alternative provider.

4. Mental Health Bill of Rights

   Pursuant to the New Hampshire Mental Health Bill of Rights, clients have certain rights. A copy of the Mental Health Bill of Rights is included here, on my website. Please review the bill of rights carefully and let me know if you have any questions.

5.  Diagnosis and Recommended Treatment

   As part of your treatment, I will discuss your diagnosis and my proposed treatment plan, including my estimated length of therapy. 

   During the initial session(s), I will be getting to know you, and evaluating your needs and my ability to meet those needs. The first session will focus mostly on review of your history, presenting concerns, and baseline assessment of symptoms. Subsequent sessions will likely include agenda-setting for our time together, discussion and/or skills building determined by your treatment goals, and may include a brief assessment of symptoms to gauge progress. If, at any time, I feel your needs would be better served by someone else or a different level of care, I will discuss it with you, make recommendations, and provide a referral. 

   You may experience uncomfortable feelings at times. On the other hand, experiencing these uncomfortable feelings and learning to tolerate distress can have long term benefits and can result in overall reductions in levels of distress. 

   You should be aware that there are alternative types of services than those being offered by me. You may prefer to get counseling from someone other than me. You also have the choice not to obtain counseling services. There are risks and benefits associated with alternatives and with not pursing any counseling. To the extent that you are interested in alternatives, please discuss this with me. I would be happy to give you the names of other mental health professionals who might meet your needs or help you find another provider.

6.  Appointments

   Please arrive promptly for all appointments. Therapy sessions are 45-60 minutes long. Payment is due via Venmo or another agreed upon payment system at the time of your visit. 

7.  Cancellations

   Once a given time is allocated for a session, another client cannot easily fill this time slot on short notice. If you must cancel your appointment, please contact Dr. Veillette as soon as possible. You will be charged the full fee for appointments that are scheduled and missed or cancelled with less than 24 hours’ notice unless we both agree that your situation was fully beyond your ability to predict or control (e.g., illness, unsafe travel conditions). Please note that payment for missed appointments is not reimbursed by your insurance provider. Repeat cancellations, even with notice, will be discussed and may be cause to pause or end treatment.

8. Confidentiality

   Under New Hampshire law, communications between clients and a licensed psychotherapist are privileged and confidential and may not be disclosed without the specific authorization of the client except under specific, limited circumstances. For example, the privilege does not apply in a civil commitment proceeding in which the issue is whether the individual is a danger to self or others, or when a client is seeking treatment related to a worker’s compensation claim. Records may also be subject to audit by regulatory authorities. Reporting laws also create exceptions. 

   In most situations, I can only release information about your treatment to others (primary care doctors, other professionals working with you) if you sign a written Authorization form. You will have the option to either give or decline consent. 

   There are specific situations covered separately by your signature on this Agreement: 1) Communication with your insurance company, at your request. The information I submit pursuant to your claims will become part of the insurance company’s files, which I have no control over. 2) Communication for protection. If you threaten to harm yourself, I may be obligated to contact family members or others who can help provide protection. 

   There are some situations where I am permitted or required to disclose information without your consent: 1) Court order. 2) Health oversight activities. If a government agency requests information for health oversight activities, I may be required to provide it. 3) Legal complaint. If you file a complaint or lawsuit against me, I may disclose relevant information in order to defend myself.

   If such situations arise, I will make every effort to fully discuss them with you before taking action, and I will limit my disclosure to what is necessary. It is important that we discuss any questions or concerns you may have about confidentiality. Please feel free to bring these up with me. 

9. Reporting Requirements

   Among the exceptions to confidentiality are New Hampshire reporting laws which require licensed psychotherapists to report to the appropriate authorities certain types of conduct. For example, any person who suspects a child or incapacitated adult has been abused, neglected, or exploited must report this to state authorities. Another example is the requirement to warn the police or likely victims of client’s “serious threat of physical violence” to a person or property.

10. Conflicts of Interest

    New Hampshire is a small state. From time to time, actual or potential conflicts of interest may arise. In the event that I become aware of a conflict of interest in providing treatment to you, I may be required to refer you to another therapist. Regardless of the existence of conflict of interest, you can be assured that any information will remain confidential.

11.  Court Ordered Treatment

    If you are seeing me due to a Court order requiring you to seek treatment, it is my policy that we not proceed with treatment until I have received a copy of the Court order and have had the opportunity to review it. Because you have been ordered by the court to obtain treatment, there are additional limits to confidentiality beyond what is forementioned in this document. For example, I may be obligated to file a report with the Court that ordered you to seek treatment or with another person or entity.

12. Group Therapy

    Unlike individual treatment, confidentiality of group therapy is not privileged, and therefore not protected by law. Group members must abide by a confidentiality agreement prior to participating in the group. Clients with concerns about confidentiality should discuss them prior to beginning treatment.

13.  Professional Boundaries

    Licensed psychotherapists are obligated to establish and maintain appropriate professional boundaries (relationships) with present and past clients (and, in some cases, client’s family members). For example, therapists should not socialize or become friends with clients and should never become sexually involved with a client.

14. Concerns or Complaints

    If you have any complaints about the treatment you have received or about billing, you should not hesitate to raise them with me. You may also contact the New Hampshire Board of Psychologists, 121 South Fruit Street, Suite 303, Concord NH 03301, 603-271-6762.

15.  Cost of Professional Services

    My billing rate is listed below, due in full at time of service.

    -Initial appointment (intake): $300

    -Therapy hour (45-60 minutes): $200

    -Missed appointments (no call >24 hrs. prior to the start of the session/no show): $200

    -Off-site meetings/consultations (in home visits): $200/hour

    -Travel: $50/15 minutes  

    -Phone calls: $50/15 minutes  

    -Records Copying: $35

    -Other services: $50/15 minutes

    -Overdue invoice by 30 days or more: $25

    I am not an in-network provider and I do not accept payment directly from insurance companies. If you would like to use your out-of-network benefits, I can provide you with an itemized receipt, which you can use to submit a claim. It is your responsibility to determine the limits of your insurance and to secure whatever authorizations might be needed.

    If you are unable to pay in full at the time of each appointment and you need to work out alternative payment arrangements (paying over time), please discuss with me and we can develop an agreement that works for both. A $25 late fee will be applied for all appointment charges overdue by 30 days or more.

    I reserve the right to collect any and all unpaid fees, including the use of a collection agency and/or small claims court. If this becomes necessary, you will be responsible for any costs incurred (typically an additional 35% of the amount owed). 

    At times, telephone contact is necessary between sessions when issues arise or a crisis occurs. Clients are encouraged to keep telephone contacts brief, if possible, and to address treatment issues during your regularly scheduled therapy session. Telephone calls exceeding 15 minutes will be prorated according to the regular session fee. This charge is not reimbursed by your insurance provider. 

16. Email and Text Communication 

    If you choose to email me from your personal email account, please limit the contents of what is shared (e.g., cancellations, change in appointment time). Please do not use text message for communication. Confidentiality is not guaranteed with email or text communication. If you choose to communicate with me via email, you do so understanding that I cannot guarantee that these modes of communication are confidential. 

17.  Limits of Service

     Unless otherwise discussed and agreed to, my role is to provide psychotherapy services, not to assess fitness, serve as a legal advocate, or act as an expert witness.

18. Limits of Availability for Emergency Coverage

    If you need to speak with me between sessions, you may contact me via the Simple Practice portal or by phone call at: 562-286-1537. Your call will be returned as soon as possible. Messages are checked regularly during regular business hours.  

    If you experience a mental health emergency, you agree to first call the National Suicide Hotline (988) or 911, or go to the nearest emergency room. 

19. Professional Records

    I maintain a file for each client. This includes intake, diagnosis, treatment plan, billing, consent to treatment, treatment notes, discharge summary, and any other written or electronic information I receive from or about the client. Treatment notes include the date and time of each session and a brief summary of key facts and issues discussed, as well as treatment recommendations. The client is entitled to a copy of the record for a fee which covers the copying and administrative costs. If you wish to see a copy of your records, I recommend that you review them with me so that we can discuss the content.

20.  Managed Care

    Dr. Laurie Veillette is not a participating provider in managed care. Most managed care companies limit the number of sessions which will be fully or partially reimbursed. Clients are encouraged to communicate directly with their managed care company about such limitations before starting treatment. Any concerns about the confidentiality of managed care should also be directed to the managed care company. You should be aware of potential risks of written diagnosis being submitted to your managed care company. 

21. Electronic Communications

    I cannot guarantee the confidentiality of electronic communications. If you do not consent to electronic communications, please inform me immediately, before beginning treatment. Please refrain from sending messages containing sensitive information electronically.