Participant Information, Registration and Authorization Form
Employer Information (if needed)
Emergency Contact information
Litigation Limitations and Fees
Should there be legal proceedings (such as, but not limited to divorce and custody disputes, injuries, lawsuits, etc.), neither you nor your attorney(s), nor anyone else acting on your behalf will call on your facilitator to testify in court or at any other proceeding, nor will disclosure of the anger management records be requested unless otherwise agreed upon. Any request for reports must be discussed and agreed upon in advance with the counselor at the start of your treatment. Please note fees for written reports, excluding progress and verification reports, do apply.
Participants are discouraged from having their counselor or records subpoenaed for litigation. Even though the participant is responsible for the testimony fee, it does not mean that the testimony will be in the participant’s favor. Testifying is only based on facts and the professional opinion of the counselor.
Although we do not provide custody evaluations or expert witness testimony, in the case your counselor does receive a subpoena, a one-week notice of any requested court appearance is required to provide the necessary time to reschedule clients. Please note that there will be an additional $300 express charge if there is less than a 1-week notice for appearance in the courtroom.
Fees related to court action are as follows:
1. Preparation Time (including submission of records): $350/hour (billable in 30-minute increments)
2. Phone calls/ virtual meetings: $250/hour (billable in 15-minute increments)
3. Depositions and/or giving testimonies: $500/hour for the specific hour required. If the general day is required, a fee of $2000 will be charged. A “general day” can include the therapist being physically present at court for the day, as well as the counselor being asked to remain on standby for the day, even if the appearance is virtual. Any travel time required will accrue a fee of $250/hour.
4. All attorney fees and costs that are incurred by the company as a result of the legal action are the participant’s responsibility. This includes consultation and conversations with attorneys, psychiatrists, and other professionals as it pertains to the case.
5. The minimum charge for any physical court appearance, not including transit time is $2000
A retainer of $2000 is due at least 72 business hours before the scheduled court appearance, and we do NOT work on a contingency basis. If your counselor is subpoenaed, and the case is continued with less than 48 business hours' notice before the beginning of the day of the scheduled court appearance and/or testimony, then you will incur an additional charge of $2500 which must be paid 24 hours before the required appearance. All fees listed above are doubled if the counselor is scheduled to be on leave or out of town, and must therefore return from or cancel their leave to accommodate the subpoena. Alternatively, the counselor may accommodate a request for a virtual appearance for the regular hourly or daily fee.
Agreement to Participate
have been provided a copy of this form when registering online. I have been given the opportunity to have any and all questions answered relevant to my participation in the Anger Management Program. I understand that this is an educational program, and not a form of psychotherapy or counseling.
I acknowledge that Anger Manager LT has no responsibility to enforce the court ruling and my attendance. I understand that it is my responsibility to attend classes and to complete the program in the amount of time allocated by the courts.
I understand that my facilitator may consult with other professionals in the field in order to plan and prepare for the classes, as well as to meet the specific needs of each participant. I have been advised regarding the limits of maintaining privacy and confidentiality.
I have read and understand the information contained in the Participant Information Sheet. I have been given the opportunity to have any and all questions answered relevant to my proposed participation.
Policy for ALL participants of Anger Management LT
1. Anger Management LT reserves the right to refuse treatment to anyone.
2. Participants must pay at the time of service. Payments are non-refundable once the service has been rendered. Any disputes will incur the full fee plus a $30 dispute or bank fee.
3. Participants are to show a copy of valid photo ID during the intake session to verify that they are who they say they are.
4. If a participant schedules an intake and does not show up for their appointment, without cancelling 24 hours in advance, they will be charged an extra $70.00 for any future appointments and they will not be refunded for the initial intake fee. They will be refunded for the work book if they choose not to continue with the program.
5. Participants agree to the confidentiality policy of Anger Management LT and are prohibited to share personal information of other members outside class sessions.
6. Anger Management LT facilitators will only release information if there is a signed consent from the client authorizing information exchange.
7. Participants are not to display any behavior that disrupts or distracts from the group process. This includes, but is not limited to the following: eating and/or drinking during group process; sleeping and inattentiveness; use of cellular phones, or other electronic/communication devices.
8. Participants are to attend sessions substance-free at all times. If the facilitator suspects that participant is under the influence of a substance, they reserve the right to dismiss participant from group. Chewing tobacco is not permitted in our program.
9. Participants are to arrive on time and remain for the entire session. Any client arriving more than 5 minutes late will not be allowed to attend class session. If a participant is late three times, the participant’s report will reflect disruptive to the class, and poor attendance.
10. Upon request, the participant shall have the right to review his/her case file with the program director, or group facilitator. An hourly fee will be charged if the process takes more than 10 minutes.
11. Partners, friends, and family members cannot be in the same anger management class together. There are many reasons for this policy. Anyone who has a close relationship with a group participant may, however, attend other anger management classes throughout our program. Anger Management LT currently offers over 12 anger management classes weekly, so there are many options
12. Children and guests are not permitted to attend group with participant.
13. Participants of Anger Management LT are to have no personal relationships with other participants outside of group.
14. Participants are not permitted to bring any weapons to session or class, including pocket knives. If there is any suspicion of weapons, participant will be dismissed from the entire program.
15. If a participant threatens to do harm or kill another person, they will be reported immediately to law enforcement and referring courts. The foreseeable victim(s) will also be warned at that time. Additionally, if the participant threatens to harm him or herself, the appropriate agency will be notified for their protection. Racial or discriminative comments will NOT be accepted and will result in termination from the program.
16. Appropriate attire is enforced in class sessions; revealing clothing will not be allowed. If questionable attire is worn in class, or obvious policy violation occurs, the facilitator/supervisor will hold a personal, private discussion with the participant to advise them regarding the inappropriateness of the attire and/or will not be permitted to participate in class session.
17.You are required to complete a pre and post assessment. This helps determine the effectiveness of the program, as well as your progress.
18. If your counselor realizes that there is a language barrier, or that the group setting is not the best fit for you, a one on one format may be recommended.
18. If your counselor realizes that there is a language barrier, or that the group setting is not the best fit for you, a one on one format may be recommended.
19. Participants attending Anger Management LT classes or sessions as a volunteer or self-referred will have to sign a “Declaration of Volunteer form” in the presence of the facilitator prior to beginning sessions. This is to indicate that Anger Management LT will not provide documentation to neither the client nor to any third parties regarding attendance or completion of classes.
20. The sign-in sheet used to track attendance does NOT serve as an official proof of enrollment and it should NOT be used as so.
21. All participants are required to purchase the workbook prior attending their second class. Participants will not be permitted to take a class without the workbook. The 2nd edition of Anger Management Essentials can be purchased through Amazon.
