Welcome! Deciding to get help is a big brave step, and you may have some questions about the process. This document contains important information about the policies of my practice. So please take some time to read it over carefully and let me know if you have any questions.
Fees, Billing and Payments
The cost of the one-on-one program is $1200.00 which includes the handbook and all additional materials. A savings of $100.00 will be given if payment is made up front. You may pay per session and these payments are be arranged to be taken out each week automatically for your convenience. Other forms of payment including cash, check, Venmo may be used. If the program is not completed for any reason, you will be charged the balance of the remaining payments (if not paid in full). No refunds will be given for any reason but may be applied to any future services at Hopeful Heart Solutions, Ltd. spiritual coaching, upcoming groups or talks, and/or life coaching for a year from the original date of when you signed up.
Because the grief process is so unique and individual, it may be that the Grief Recovery Method program may need to extend beyond the 8 weeks. If this happens, additional sessions will be charged individually at a rate of $150.00 until completion is achieved.
I require a valid credit card to be kept on file, which will be charged without notice for the following circumstances: 1) the agreed upon Grief Recovery Method payment dates as per the signed registration agreement. 2) if payment is considered past due. 3) if a session is cancelled with less than 24-hour notice. 4) no-shows (client does not call or show for appointment).
InsuranceContacting Me
I check my phone and email frequently, but am often not immediately available. I will do my best to get back to you within 24 hours on Monday-Friday. I will return any email or phone messages left during the weekend on Mondays. If your schedule will make it difficult for me reach you by phone, please include in your voicemail some times that I am most likely to be successful in returning your call. If you are unable to reach me, and do not believe that you can wait to receive my return call, please call your primary care physician or go to your nearest emergency room. In the case of a life- threatening emergency, please call 911.
Lastly, I prefer that text is only used for scheduling purposes, unless we have discussed an alternate arrangement. If you choose to email me about any personal or clinical information, please be aware that there is some inherent risk in doing so because email is not entirely secure and confidential.
By checking the box below, I am indicating that I have read and understood this form and that I agree to participate with Gwen Russo of Hopeful Heart Solutions, Ltd. in accordance with the above policies.
Gwen Russo of Hopeful Heart Solutions, Ltd. reserves the right to charge your credit card on the agreed upon date(s) as stated in the registration agreement, for sessions cancelled with less than 24-hour notice or if fees are not paid in a timely manner as outlined in the Practice Policies and Procedures Form. Your credit card may by charged at any time once payment is considered due or past due. I may not notify you before I charge your card under these circumstances.
By checking the box below indicates your understanding and acceptance of this policy and hereby authorizes Gwen Russo of Hopeful Heart Solutions, Ltd. to charge your credit card for the above mentioned conditions.
I understand that the Grief Recovery Method sessions are not intended to be or substitute for professional medical or mental health services, and I will not rely on the sessions as a substitute for professional medical or mental health services. I understand that my participation will not (i) qualify me to lead or conduct Grief Recovery Method sessions or similar sessions, or (ii) make me a Grief Recovery Method Specialist, certified by The Grief Recovery Institute. I will not receive a license to use GRI’s name or any of GRI’s trademarks.
Confidentiality Statement
I understand that as a participant in the Grief Recovery Method ® program, I may have access to personal information about my AGRMS, Gwen Russo. I understand that I am obliged to maintain the confidentiality of this information at all times. I understand I am not to store, discuss, interpret or otherwise relay this personal information. I further understand that violation of these privacy and confidentiality considerations could be subjected to legal action. I agree by my signature that I understand these privacy and confidentiality considerations.
I as the participant understand that The Grief Recovery Method is not intended to be or substitute for professional medical or mental health services, and I will not rely on the sessions as a substitute for professional medical or mental health services. I understand that my participation will not (i) qualify me to lead or conduct Grief Recovery Method sessions or similar sessions, or (ii) make me a Certified Grief Recovery Method Specialist, certified by The Grief Recovery Institute. I will not receive a license to use GRI’s name or any of GRI’s trademarks.
In consideration of receiving the services, on behalf of myself and my representatives, successors, heirs and assigns I release, hold harmless and waive the right to bring any claim against Grief Recovery Institute or Hopeful Heart Solutions, Ltd. and their affiliates, licensees, employees, directors, officers, shareholders and agents arising from or related to my participation in the sessions, except for claims arising from their reckless or intention- ally wrongful acts, including without limitation claims for injury, death, property damage or loss. If this release conflicts with applicable law, I intend to release claims to the extent permitted by applicable law.
By checking the box below, I am indicating that I have read and understood this form and that I agree to participate with Gwen Russo of Hopeful Heart Solutions, Ltd. in accordance with the above policies.
