Practice Policies and Informed Consent
Effective Date: 12/27/2025
Provider Information
Jessica Reis, LMFT
Licensed Marriage and Family Therapist
State of New York
The Intimacy Room Marriage and Family Therapy PLLC provides outpatient psychotherapy services via secure telehealth platforms.
Scope of Services
Psychotherapy services may include individual therapy and couples therapy. Services are provided for personal growth, emotional support, relational concerns, and mental health treatment within the scope of licensed marriage and family therapy.
This practice does not provide emergency services, crisis intervention, or on-call availability. If you are experiencing an emergency, you are responsible for contacting local emergency services or dialing 988.
Informed Consent for Therapy
Psychotherapy is a collaborative process that involves active participation. While therapy can be beneficial, outcomes are not guaranteed. You have the right to ask questions, to participate voluntarily, and to withdraw from therapy at any time.
By engaging in services, you acknowledge that therapy may involve discussing difficult emotions, experiences, or topics.
Telehealth Informed Consent
All services are provided via telehealth.
Telehealth involves the use of electronic communications to deliver mental health services remotely. While telehealth offers convenience and accessibility, potential risks include technical failures, interruptions, or unauthorized access despite reasonable safeguards.
You agree to:
Participate from a private, safe location
Ensure you are physically located in New York State at the time of each session
Notify the therapist of your location at the start of sessions when requested
Telehealth may not be appropriate for all clinical situations. Services may be discontinued if telehealth is no longer clinically appropriate.
In the event of an emergency, you are responsible for contacting local emergency services.
Confidentiality and Its Limits
Confidentiality is a foundational aspect of therapy. Information shared in sessions is kept confidential except in circumstances required by law, including but not limited to:
Risk of serious harm to yourself or others
Suspected abuse or neglect of a child, elder, or dependent adult
Court orders or other legal requirements
Only the minimum necessary information is disclosed when required.
Fees and Payment
This is a private pay practice. Insurance is not accepted.
Payment is due at the time of service. Accepted forms of payment will be provided during onboarding. Fees are discussed prior to the start of services.
Cancellation and Missed Appointments
A minimum of 48 hours’ notice is required for cancellations or rescheduling.
Appointments canceled with less than 48 hours’ notice, as well as missed appointments, are subject to the full session fee. Exceptions may be made at the therapist’s discretion for extenuating circumstances.
Communication and Boundaries
Communication outside of sessions is limited to scheduling and administrative matters. Email and electronic messaging are not appropriate for urgent matters or therapeutic processing.
Social media is not used for communication with clients. To protect confidentiality, connection requests from current or former clients will not be accepted.
Records and Documentation
Clinical records are maintained in accordance with professional and legal standards. You may request access to your records in writing, subject to legal limitations.
Records are retained for the period required by New York State law.
Termination of Services
You may end therapy at any time. The therapist may also initiate termination if services are no longer clinically appropriate, if boundaries are violated, or if payment policies are not upheld. Referrals may be provided when appropriate.
Consent
By engaging in psychotherapy services with The Intimacy Room Marriage and Family Therapy PLLC, you acknowledge that you have read, understood, and agreed to these practice policies and informed consent terms.