PRACTICE POLICIES

RIVERWOOD PSYCHOTHERAPY LLC

EFFECTIVE DATE: July 1, 2026

Welcome to RIVERWOOD PSYCHOTHERAPY LLC. This document details the specific Practice Policies and governing terms of service you are agreeing to. By beginning or continuing treatment, you acknowledge and accept these terms.

I. CORE TERMINOLOGY

• The Practice: RIVERWOOD PSYCHOTHERAPY LLC, including its administrative staff and digital infrastructure (“The Practice,” “Us,” “We”).

• Provider: The licensed clinician, associate, or intern authorized to deliver services.

• Client: The individual, couple, or family unit seeking and receiving services. Per ORS 109.675, any client fourteen (14) years of age or older must sign this disclosure personally.

• Treatment: Psychological services including assessment, diagnosis, psychotherapy, and consultation.

II. ENTITY & PROVIDER INFORMATION

Practice Name: RIVERWOOD PSYCHOTHERAPY LLC

Address: 1825 NE Broadway Street, Suite G, Portland, OR 97232, USA

Tel. (971) 328-3919

Email. info@riverwoodpsych.com

**James Boyda, LPCLicense #C10570 (OR)**

• Education: M.A. in Counseling, Northwestern University, Evanston, IL (2020)

• Specialized Training: Cognitive-Behavioral Interventions in Cancer Support Care (2019)

• Philosophy: Integrates Cognitive-Behavioral, Family and Trauma Systems, Mindfulness-based Cognitive, Positive Psychology, and Psychodynamic therapies.

**Collin King, LPCLicense #C10262 (OR)**

• Education: M.A. in Counseling Psychology, University of Denver, Denver, CO (2021)

• Philosophy: Integrates Gestalt, Internal Family Systems (IFS), Somatic Processing, and Psychodynamic therapies.

III. FEES, ATTENDANCE, & CANCELLATIONS

Standard Fees

• Individual Session: $150

• Couples/Family Session: $180

• Duration: 50–55 minutes.

• Payment: Fees are due at the time of service. An authorized credit card must be kept on file and will be charged automatically on the morning of the session or within 24 hours.

• Insurance: For individual therapy sessions, we bill insurance as a courtesy service to you, the Client. Co-pays are determined by your individual plan and due at the time of service. Pre-authorization is not a guarantee of payment, and claims may still be denied or adjusted; therefore, the client remains legally and financially responsible for any portion of the fee not covered or paid by the insurer.

• Couples Therapy Services: In most cases, your insurance can be used to pay for couples services if the following requirements are met:

  • Diagnosis: At least one partner (the primary policyholder or a covered dependent) meets the criteria for a mental health diagnosis.

  • Impact: Relationship or family issues are directly impacting that person's mental health symptoms.

  • Treatment: We are ethically able to bill insurance when treating those symptoms through a family systems lens.

  • While this process typically allows for insurance billing, please consult with your individual insurance plan prior to starting services to confirm whether family or couples therapy is covered under your specific plan.

Cancellations & Missed Appointments

• 24-Hour Rule: We require 24 hours' notice for cancellations or rescheduling.

• Fees: Late cancellations (with less than 24 hours’ notice) or "no-shows" incur an automatic $100 fee.

• Grace Waiver: Each Client or Case (individual, couple, or family unit) is permitted one waived late fee per calendar year for unforeseen emergencies or illness, which will be automatically applied to the first late cancellation or no-show. Eligibility for the waiver is determined at the Practice's discretion.

• Missed Intake Sessions: Grace waivers are not applicable for missed Intake (initial) sessions, which will automatically be charged a $100 fee. Rescheduling missed Intake sessions is at the sole discretion of the Provider.

Insurance & Ancillary Charges

• Responsibility: While we may bill insurance as a courtesy, the Client is responsible for all co-pays, deductibles, and non-covered fees. Pre-authorization from your insurance provider is not a guarantee of payment. Final coverage is determined by your insurer only when a claim is processed. You are ultimately responsible for all fees, including those denied by insurance.

• Ancillary Work: Coordination with third parties or report writing exceeding 10 minutes is billed at $25.00 per 15-minute increment.

Attendance Policy

• To ensure all clients have timely access to services, we adhere to the following policy regarding consecutively missed appointments:

  • Two (2) Missed Appointments: You will be removed from the automatically recurring schedule. To continue services, you will be transitioned to session-by-session scheduling, where appointments must be booked individually based on current availability.

  • Three (3) Missed Appointments: This will be considered a voluntary withdrawal from services and will result in the immediate closure of your case.

  Note: If your case is closed and you wish to resume services in the future, you will need to reapply or go through the intake process again, subject to current availability and waitlist times.

• Non-communication following a missed session or outreach (voicemail or email) from your provider for a period of 30 days will also be considered a voluntary withdrawal from services and result in clinical file closure.

• Consistent attendance is an important part of effective therapy. If you have three (3) or more late cancellations or missed appointments within a rolling three-month period, we will collaboratively review whether your current treatment schedule continues to meet your needs. This is not a penalty, but an opportunity to discuss barriers to attendance, reassess treatment readiness, and determine whether adjustments to scheduling, frequency of sessions, or a temporary pause in treatment would better support your care.

• Frequent On-Time Cancellations: While on-time cancellations do not count as missed appointments, frequent cancellations may impact clinical progress. At our discretion, we reserve the right to review the fit of services and work collaboratively with you to identify alternatives that better support your needs if frequent on-time cancellations become a barrier to providing you with effective care.

IV. FINANCIAL RESPONSIBILITY & TERMINATION

• Service Pause: If a balance remains unpaid for 2 consecutive sessions or exceeds 15 days, services will be paused until the account is settled or a written payment plan is put into place. Future appointments will also be taken off the schedule.

• Administrative Termination: If a balance is unpaid for 30 days without communication, a formal 30-day termination process begins. We will inform you in writing via mail or e-mail of this process.

• Non-Abandonment: We will provide at least three (3) referrals to ensure continuity of care. Services will not be terminated during an active clinical crisis.

V. PRIVACY & CONFIDENTIALITY

Information remains confidential per HIPAA and Oregon law, with the following exceptions:

1. Written consent from the client.

2. Legal action against the Provider or Court Orders.

3. "Duty to Warn": Intent to commit a crime or harm oneself/others.

4. Mandatory reporting of suspected abuse or neglect of a minor or a vulnerable adult.

5. Official OBLPCT board investigations.

6. Minor Consent (14–17): Providers must involve parents/guardians by the end of treatment unless a clinical reason exists to withhold information.

VI. ELECTRONIC DELIVERY AGREEMENT

• Consent to Electronic Communication: By signing this document, you explicitly consent to receive all practice-related communications, clinical documents, invoices, and legal notices—including Administrative Termination notices—exclusively via electronic means (e.g., secure email or client portal).

• Waiver of Physical Mail: You acknowledge that the Practice will not send hard-copy documents via USPS or other physical mail services unless specifically required by law or requested by you in writing.

  • It is your responsibility to maintain a valid email address on file and to notify the Practice immediately of any changes to your electronic contact information.

VII. TELEHEALTH & SAFETY

• Jurisdiction: The client must be physically located in Oregon during every session.

• Environment: Sessions must occur in a private, stationary location. Sessions will be terminated (without refund) if conducted while driving or in public spaces.

• Technology: The client is responsible for their internet connection. If the Provider's connection fails, no fee is charged, and the session will be rescheduled.

VIII. OREGON CLIENT BILL OF RIGHTS

As a consumer of counseling services in Oregon, you have the right:

• To ask questions about methods, risks, and benefits.

• To be free from discrimination (race, gender, religion, orientation, etc.).

• To receive a Good Faith Estimate of costs.

• To decline specific interventions or request a different provider.

• To report complaints to the licensing board.

IX. SCOPE OF SERVICE & EXCLUSIONS

• Excluded Services: The following fall outside our scope of expertise and practice: interpersonal violence, abuse, high-risk behavior, or substance use meeting the criteria for a Substance Use Disorder in couples or family cases; substance use requiring medical treatment; Substance Use Disorder in early recovery (less than 12 months); active anger management; eating disorders requiring medical treatment; acute mental health hospitalization within the past 12 months; and severe or persistent mental illness involving psychotic features or processes.

• Referrals: If we assess that your clinical needs fall beyond our scope of practice, we will refer you to appropriate providers. You are encouraged to follow up with these referrals, but the choice of provider remains yours. Please note that while we provide these recommendations as a professional courtesy, we do not have control over the availability or services of external providers. In the event of a referral, our professional relationship will formally conclude once the transition has been facilitated.

• Zero Tolerance Policy: This practice maintains a strict Zero Tolerance Policy regarding any form of abusive, threatening, or harassing behavior. To ensure a safe and therapeutic environment, verbal insults, physical threats, discriminatory language, and sexual harassment toward the therapist or staff—whether in person, via telehealth, or through digital communication—will not be tolerated. Any violation of this policy may result in the immediate termination of the current session and the formal discharge of the client from the practice. In the event of termination for cause, the client will be provided with a brief explanation of the breach and a list of external referrals to ensure continuity of care, while any direct threats to safety will be reported to the appropriate authorities.

• Crisis Care: We are not a 24-hour crisis facility. In an emergency, dial 911 or 988.

X. BOARD CONTACT INFORMATION

Questions or complaints may be directed to:

Oregon Board of Licensed Professional Counselors and Therapists

3218 Pringle Rd SE #120, Salem, OR 97302

Tel: (503) 378-5499Email: lpct.board@mhra.oregon.gov

XI. ACKNOWLEDGMENT & CONSENT

By reviewing this document, I acknowledge that I have read, understood, and agreed to the terms above, including the general terms of service, financial policies, participation policies, telehealth requirements, and scope of service.