FAQ

If you are experiencing a crisis and are in need of immediate care please call 911 or go to your nearest emergency room. For local crisis numbers, national crisis lines and online crisis support please go to the Oregon crisis line webpage.

Due to only providing counseling services online, my limited work hours, and to provide proper care to individuals, the telehealth services I offer are not appropriate for anyone who is actively suicidal, homicidal or who has a severe mental health illness that could require a higher level of care than online therapy can provide. 

If a crisis arises while I am working with an individual or couple, I will address it, provide support, and make therapeutic recommendations and any needed referrals.

I work with adults ages 18+.  I work with individuals and couples.

I provide counseling services and return calls and emails during the following business hours:

Monday: 3:30pm-7:00pm 

Saturday: 8:00 am-1:00pm

Sunday: 8:00 am-1:00pm.

*Not open on some holidays

I only accept EAP Lyra Health.  I do not take any other EAP or insurance. However, I also offer a limited number of sliding scale spots.  I accept debit, credit, Health savings card (HSAs) and flexible spending account (FSAs) cards. See Fee page for prices. 

See my Fee page for full details: 

In short, not taking insurance allows me to have a smaller caseload, permitting me to provide a higher quality of care to the individuals and couples I see.

Paying out of pocket provides you with more mental health options.  Overall it allows you to take charge regarding your health and medical record.

Yes I can. Every month I can provide you with a document, called a superbill that contains all the information insurance companies ask for.  You can then submit this form to your insurance company for reimbursement. By calling your insurance provider you can learn whether you have out of network benefits. *Please note that insurance will only cover therapy if you have a diagnosis. This includes if you are using out of network benefits.  

You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.

You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.

I will call you during your scheduled consultation time to begin the process. Thereafter, if you decide you would like to work with me, we will schedule your first appointment.  Once you schedule your first appointment called the assessment (not the consult), you will receive an email with intake paperwork. I ask that you complete the forms 24 hours prior to your scheduled assessment appointment to confirm your appointment. After your assessment appointment is confirmed, you will receive an email with a link, that will allow you to access your scheduled video session. Thereafter, we will continue to setup video appointments and meet via video.

You will need a device with an accessible camera and microphone. The video platform program is accessible via a PC & Mac (Chrome|Firefox|Safari) and Android (Chrome) and iOS (Safari).

If you plan to use a desktop or laptop, there is nothing to download prior to your appointment. *If you plan on using your phone download Telehealth by SimplePractice (for iOS or Android) in the app store.

It can be a concerning feeling that things you say or do in therapy could “get out.” Your privacy and trust are of utmost importance to me. 

The law protects the privacy of all communication between a client and a therapist. In most situations, I can only release information about your treatment to others if you sign a written authorization form that meets certain legal requirements imposed by HIPAA.  There are some situations where I am permitted or required to disclose information without either your consent or authorization.  If such a situation arises, I will limit my disclosure to what is necessary. 

 Reasons I may have to release your information without authorization:

1.   If you are involved in a court proceeding and a request is made for information concerning your diagnosis and treatment, such information is protected by the psychologist-patient privilege law.  I cannot provide any information without your (or your legal representative’s) written authorization, or a court order, or if I receive a subpoena of which you have been properly notified and you have failed to inform me that you oppose the subpoena.  If you are involved in or contemplating litigation, you should consult with an attorney to determine whether a court would be likely to order me to disclose information.
2.   If a government agency is requesting the information for health oversight activities, within its appropriate legal authority, I may be required to provide it for them.
3.   If a patient files a complaint or lawsuit against me, I may disclose relevant information regarding that patient in order to defend myself.
4.   If a patient files a worker’s compensation claim, and I am providing necessary treatment related to that claim, I must, upon appropriate request, submit treatment reports to the appropriate parties, including the patient’s employer, the insurance carrier or an authorized qualified rehabilitation provider.
5.   I may disclose the minimum necessary health information to my business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services.  My business associates sign agreements to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.

There are some situations in which I am legally obligated to take action, which I believe are necessary to attempt to protect others from harm, and I may have to reveal some information about a patient’s treatment:

1.   If I know, or have reason to suspect, that a child under 18 has been abused, abandoned, or neglected by a parent, legal custodian, caregiver, or any other person responsible for the child’s welfare, the law requires that I file a report with the Oregon Abuse Hotline. Once such a report is filed, I may be required to provide additional information.
2.   If I know or have reasonable cause to suspect that a vulnerable adult has been abused, neglected, or exploited, the law requires that I file a report with the Oregon Abuse Hotline. Once such a report is filed, I may be required to provide additional information.
3.   If I believe that there is a clear and immediate probability of physical harm to the patient, to other individuals, or to society, I may be required to disclose information to take protective action, including communicating the information to the potential victim, and/or appropriate family member, and/or the police or to seek hospitalization of the patient.

If you have specific questions about how confidentiality works, you can ask during a free phone consultation or anytime during our work together.

Your privacy is very important to me.  I use a HIPAA Compliant video platform for my video appointments, which was designed for telemedicine that is encrypted to protect your privacy. I, nor the video platform will record or save any personal information. 

I also provide security in my workspace by being the only one in the room. To add privacy on your end I would recommend you going to a space where no one else is around, such as an extra room, office, your car if needed or even a walk. It is also helpful to use headphones so that no one else can hear what I am saying.

Yes, I am a native Spanish speaker and can provide therapy in Spanish and English.

Cancellation of sessions once you are an established client:

If you must cancel or reschedule an appointment, 24-hour advance notice is required, otherwise you will be held financially responsible.  Should you cancel or miss an appointment with notification less than 24 hours will result in being charged the full fee for your missed appointment. Cancellations must be communicated by phone, not email or text. If something like an emergency occurs within less than 24 hours, communicate with the therapist to avoid incurring a fee. If clients have more than 2 cancellations during the course of treatment the therapist and client may re-evaluate the needs, desires, and motivation for on-going treatment.

No, I am not licensed to prescribe medications. I also do not currently work with a psychiatrist.  However, I am able to consult with your doctor, whether it be a psychiatrist or primary care physician, to further improve your quality of care.

Therapy can be vulnerable and new, so it’s natural to be nervous. It can be scary to think of opening up or crying in front of someone new, perhaps fearing that it will be awkward and uncomfortable. The fear around that can feel overwhelming. Taking steps to seek help for the challenges we face is a huge step. It takes courage to realize we can’t face our issues alone.

Therapy is a space where you can be yourself without being judged, including feeling nervous. I’m committed to finding a way to care for your nervousness and ensure sessions are as comfortable as possible.

I’m here if you want to talk about it during a free phone consultation.

Finding a therapist you connect with and feel comfortable with is important. Research has shown that the relationship a client has with their therapist is one of the best predictors of the success the client will have in therapy. I recommend you research and reach out to different therapists, until you find one that you feel comfortable with and able to connect with. Most therapists offer a free consultation.

Take your time to read through my website. If you sense that I may be a good fit based on what you are reading, you can schedule yourself in my online scheduler, for a free 20-30 minute consultation.

During a free phone consultation, you can ask me how I work as a therapist, or any other questions you may have that are specific-to-you. You’ll also be able to share what’s going on for you and I will let you know how I can help.

It may be helpful to think of the first few sessions as trying out the waters together. During these sessions, you’ll be able to see how you feel working with me. My approach is not going to work for everyone. What’s most important to me is that you find someone who you feel is the right fit for you. We can explore that together.

It’s normal if you don’t feel ready to share something. During our sessions, I will never push you to talk about something you’re not comfortable talking about. I’ll be there to guide you towards discovering what feels comfortable for you to share. Working with pace, we can look at the tough stuff when you’re ready.

You can also share with me that you are nervous to open up about something and we can talk about that too. Whatever is present for you.  Whatever you are going through, bring that to the session and we can explore that together.

If you open up to me, I will not think you are crazy. You are a human who has experienced things in life and need some support to get through the challenges you are currently going through. We all experience difficult life stuff at some point in our life. Many of my clients have had that same fear.  Working with my clients has shown me that the challenges you are facing are normal and natural.  You’re not being dramatic or “too much.” Nothing you can say will cause me to judge you or scare me away.  I know nobody’s perfect, we all have our strengths and weaknesses, we all suffer in different ways.  Whatever it is you’re going through, I provide a safe space where you can feel heard and supported without judgement

The first 3 sessions for couples,  and the first session for individuals is an assessment session. I use this time to help me begin learning about you as an individual or couple and the challenges that brought you into counseling. I’ll invite you to share more about yourself and we can also talk about what’s worked or not worked for your mental health in the past.

You can ask me questions as well. The most important part of a first session is that you see if you feel I’m a good fit for you. If you feel comfortable with me, and would like to continue working with me we can schedule another appointment.

Below is the structure of the assessment sessions:

For individuals: 

I will complete an assessment with you during your first appointment, allowing me to learn more about you and your challenges. Sometimes during he assessment sessions we also discuss your counseling goals. If we don’t get to it during the first appointment, we will explore and discuss them during your second appointment.  After I’ve learned more about who you are and what you are hoping to get out of therapy we will begin working towards your goals. 

For couples:

During the first appointment I will see both of you and begin the assessment process, which will span 3 sessions. The first session will allow me to get to know both of you as a couple. After this appointment you will both need to fill out questionnaires online independently before your next appointment. Once the questionnaires online are complete I will see each of you for independent sessions to allow me to get to know you both as individuals. Then I will compile everything I have learned about your relationship and we can create your relationship goals together in a session with both of you. From there, we will begin working towards your goals.

Yes. For me to gain a full understanding of your relationship and your struggles and strengths as a couple, I ask that both partners fully complete the questionnaires online, independently and privately. 

Health Insurance Portability Accountability Act (HIPAA)
Client Rights & Therapist Duties
This document contains important information about federal law, the Health Insurance Portability and Accountability Act (HIPAA), that provides privacy protections and patient rights with regard to the use and disclosure of your Protected Health Information (PHI) used for the purpose of treatment, payment, and health care operations. HIPAA requires that I provide you with a Notice of Privacy Practices (the Notice) for use and disclosure of PHI for treatment, payment and health care operations. The Notice explains HIPAA and its application to your PHI in greater detail. The law requires that I obtain your signature acknowledging that I have provided you with this. If you have
any questions, it is your right and obligation to ask so I can have a further discussion prior to signing this document. When you sign this document, it will also represent an agreement between us. You may revoke this Agreement in writing at any time. That revocation will be binding unless I have taken action in reliance on it.

LIMITS ON CONFIDENTIALITY
The law protects the privacy of all communication between a patient and a therapist. In most situations, I can only release information about your treatment to others if you sign a written authorization form that meets certain legal requirements imposed by HIPAA. There are some situations where I am permitted or required to disclose information without either your consent or authorization. If such a situation arises, I will limit my disclosure to what is necessary. Reasons I may have to release your information without authorization:
1. If you are involved in a court proceeding and a request is made for information concerning your diagnosis and treatment, such information is protected by the psychologist-patient privilege law. I cannot provide any information without your (or your legal representative’s) written authorization, or a court order, or if I receive a subpoena of which you have been properly notified and you have failed to inform me that you oppose the subpoena. If you are involved in or contemplating litigation, you should consult with an attorney to determine whether a court would be likely to order me to disclose information.
2. If a government agency is requesting the information for health oversight activities, within its appropriate legal authority, I may be required to provide it for them.
3. If a patient files a complaint or lawsuit against me, I may disclose relevant information regarding that patient in order to defend myself.
4. If a patient files a worker’s compensation claim, and I am providing necessary treatment related to that claim, I must, upon appropriate request, submit treatment reports to the appropriate parties, including the patient’s employer, the insurance carrier or an authorized qualified rehabilitation provider.
5. I may disclose the minimum necessary health information to my business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. My business associates sign agreements to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.

There are some situations in which I am legally obligated to take actions, which I believe are necessary to attempt to protect others from harm, and I may have to reveal some information about a patient’s treatment:
1. If I know, or have reason to suspect, that a child under 18 has been abused, abandoned, or neglected by a parent, legal custodian, caregiver, or any other person responsible for the child’s welfare, the law requires that I file a report with the Oregon Abuse Hotline. Once such a report is filed, I may be required to provide additional information.
2. If I know or have reasonable cause to suspect that a vulnerable adult has been abused, neglected, or exploited, the law requires that I file a report with the Oregon Abuse Hotline. Once such a report is filed, I may be required to provide additional information.
3. If I believe that there is a clear and immediate probability of physical harm to the patient, to other individuals, or to society, I may be required to disclose information to take protective action, including communicating the information to the potential victim, and/or appropriate family member, and/or the police or to seek hospitalization of the patient.

CLIENT RIGHTS AND THERAPIST DUTIES
Use and Disclosure of Protected Health Information:
● For Treatment – I use and disclose your health information internally in the course of your treatment. If I wish to provide information outside of our practice for your treatment by another health care provider, I will have you sign an authorization for release of information. Furthermore, an authorization is required for most uses and disclosures of psychotherapy notes.
● For Payment – I may use and disclose your health information to obtain payment for services provided to you as delineated in the Therapy Agreement.
● For Operations – I may use and disclose your health information as part of our internal operations. For example, this could mean a review of records to assure quality. I may also use your information to tell you about services, educational activities, and programs that I feel might be of interest to you.
Patient’s Rights:
● Right to Treatment – You have the right to ethical treatment without discrimination regarding race, ethnicity, gender identity, sexual orientation, religion, disability status, age, or any other protected category.
● Right to Confidentiality – You have the right to have your health care information protected. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. I will agree to such unless a law requires us to share that information.
● Right to Request Restrictions – You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, I am not required to agree to a restriction you request.
● Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations.
● Right to Inspect and Copy – You have the right to inspect or obtain a copy (or both) of PHI. Records must be requested in writing and release of information must be completed. Furthermore, there is a copying fee charge of $1.00 per page. Please make your request well in advance and allow 2 weeks to receive the copies. If I refuse your request for access to your records, you have a right of review, which I will discuss with you upon request.
● Right to Amend – If you believe the information in your records is incorrect and/or missing important information, you can ask us to make certain changes, also known as amending, to your health information. You have to make this request in writing. You must tell us the reasons you want to make these changes, and I will decide if it is and if I refuse to do so, I will tell you why
within 60 days.
● Right to a Copy of This Notice – If you received the paperwork electronically, you have a copy in your email. If you completed this paperwork in the office at your first session a copy will be provided to you per your request or at any time.
● Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI regarding you. On your request, I will discuss with you the details of the accounting process.
● Right to Choose Someone to Act for You – If someone is your legal guardian, that person can exercise your rights and make choices about your health information; I will make sure the person has this authority and can act for you before I take any action.
● Right to Choose – You have the right to decide not to receive services with me. If you wish, I will provide you with names of other qualified professionals.
● Right to Terminate – You have the right to terminate therapeutic services with me at any time without any legal or financial obligations other than those already accrued. I ask that you discuss your decision with me in session before terminating or at least contact me by phone letting me know you are terminating services.
● Right to Release Information with Written Consent – With your written consent, any part of your record can be released to any person or agency you designate. Together, we will discuss whether or not I think releasing the information in question to that person or agency might be harmful to you.

Therapist’s Duties:
● I am required by law to maintain the privacy of PHI and to provide you with a notice of my legal duties and privacy practices with respect to PHI. I reserve the right to change the privacy policies and practices described in this notice. Unless I notify you of such changes, however, I am required to abide by the terms currently in effect. If I revise my policies and procedures, I will provide you with a revised notice in office during our session.

COMPLAINTS
If you are concerned that I have violated your privacy rights, or you disagree with a decision I made about access to your records, you may contact me, the State of Oregon Department of Health, or the Secretary of the U.S. Department of Health and Human Services.

Cascades Counseling Services LLC *Elinor Tejeda MA., LPC * 503-765-6171
4760 Harcourt Ave. NE
Keizer, OR. 97303
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