Client Information

We want families to feel informed and comfortable before starting services. Below are important documents that outline how services are provided, along with your rights and responsibilities.

 

Before beginning services, families will be asked to review and sign the following forms via Carepatone:

• Sign the Terms & Conditions Agreement

• Acknowledge the HIPAA Notice

• Complete the Intake Form

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Fees and Attendance Policies (For complete details, please refer to our full Terms and Conditions available on the Client Portal)
 

1. Financial Agreement

General Terms

• All services are provided on a private-pay basis, unless authorized through a funding source such as the Regional Center (Early Start program). Please review the current fee schedule.

• All payments are non-refundable and non-transferable.

• Sessions begin and end at the scheduled time. Late arrivals will still end at the scheduled time with no extension provided, and full session rates apply.

• If the clinician is unable to begin the session because the client/child is unavailable (e.g., not home or not ready), the session will be considered a missed session and charged at the full rate.
   

Private Pay & Payment Terms

• First Appointment Hold: To confirm your first appointment, WST requires a credit card on file with a nominal $1.00 authorization charge at the time of booking.

• First Session: The remaining balance for your initial appointment will be charged at the start of your session.

• No-Show / Late Cancellation: If you miss your initial appointment or cancel late, your card on file will be charged the remaining balance of the full session fee (e.g., $249 remaining on a $250 fee) in accordance with our cancellation policy.

• Ongoing Sessions: Full payment is processed at the beginning of each session.

• Superbills: WST can provide a superbill upon request. The client is responsible for understanding their insurance benefits. WST does not guarantee insurance reimbursement.

• Services are provided within a 10-mile radius of ZIP code 95035. Appointments located more than 10 miles from 95035 will incur an additional $25 travel fee. For example, if the service fee is $250, the total invoice amount will be $275.

Returned Payment Fee:

• A $25.00 service fee will apply to any returned check or failed/declined credit card transaction. Subsequent returned checks will incur a $35.00 fee pursuant to California Civil Code § 1719. All outstanding balances (including session fees and returned payment charges) must be settled prior to continuing services.
   

SARC Regional Center (Early Start)

• Services authorized through a Regional Center are billed directly to the Regional Center. Families remain responsible for attending scheduled sessions and providing active documentation (e.g., IFSP, authorizations).

• If authorization expires, is denied, or lapses, and the client chooses to continue services, the account will transition to Private Pay status, and private pay rates will apply.

• SARC clients must follow the attendance policy. Violating such policy may result in discharge.
   

Attendance & Cancellation Policy

• 48-Hour Notice: A minimum of 48 hours' advance notice is required to cancel or reschedule a session.

• Late Cancellations & No-Shows: Cancellations made with less than 48 hours' notice or no-shows will be charged at the full session rate.

• Illness: If the child or a household member is ill, families must notify the clinician as soon as possible via call or text at 415-857-5783.

• Extended Absence: Families planning an extended absence (longer than 2 weeks) must provide at least four (4) weeks' advance notice via email to vivian@waleespeechtherapy.com.

• Caregivers must be present and are expected to actively participate during therapy sessions. To maintain engagement, caregivers are asked to limit cell phone use during sessions unless necessary.
   

HIPAA Notice of Privacy Practices

• This document explains how your child’s health information may be used and protected, as well as your rights regarding that information.

• Your child’s privacy and confidentiality are always respected and protected.

• Download HIPAA Notice (PDF)