Preston Counseling

Charlotte Therapists

Frequently Asked Questions (FAQ)

How do I schedule and appointment?

Just call Greg at 704-787-1793, or email him at gpreston003@gmail.com.
 You can email me with your phone number and the best time to reach
you.  If I don't answer my phone when you call, just leave a message
with your name and phone number, and I'll call you back as soon as
possible.  It's confidential, I'm the only one that hears the message,
so you can leave personal information, if you would like.

Do you take insurance?

I take most major health insurance plans, and managed care plans.
Including Aetna, Blue Cross/Blue shield, CBHA, Cigna, Magellan,
Medcost, Medicaid, United Healthcare, Value Options, and NC State
Health Plan.

Will my insurance cover counseling/psychotherapy?

 The only way to know is to contact your health plan and ask them what
your benefits are for mental health, and/or substance abuse (if
applicable).  While on the phone with them, ask your representative
what your copay is, deductible (if any), how many visits do they cover
per benefit period, and if the benefit period runs on a calendar year
or benefit year.  Write this information down and bring it along with
your insurance card to your first appointment.

How long are appointments and how many will I need?

Appointments are approximately 50 minutes long.  Most clients benefit
from sessions once a week initially.  Then, based on progress we can
go to every other week and so on.

Since each client is unique and has different goals, this varies.  If
the problems are relatively simple and clear, it may only take five
sessions.  If the issues are more complex and deep, it may take ten to
twenty sessions or more.  Most of my client's feel a sense of relief
and insight within 12 sessions.

What if I am uncomfortable with the idea of counseling/psychotherapy?

It is better to face our fears then run and hide from them. People
often try to distract from their issues with alcohol, drugs,
avoidance, being hyperbusy, and other maladaptive coping strategies.
Sometimes initially people feel a little worse before they get better.
 This is because those people have defended against negative feelings
by denying, compartmentalizing, and avoiding looking at themselves
clearly.  Or because this is all he or she was taught, so therapy can
be uncomfortable at first.  However, these issues have a way of coming
out in bad ways, and controlling us, instead of us controlling the
issues.

Lake Norman Therapists

Myths About Counseling

Counseling is a sign of weakness: Nothing could be further from the
truth. It takes courage to acknowledge a problem or difficulty.
Entering counseling is an important first step in resolving the
problem.

Counseling is only for people with serious emotional problems:
Although counseling can be beneficial for people who do have serious emotional problems, it is also helpful for people with everyday
concerns such as adjustment or phase of life issues.

Counseling is advice giving: By the time many people come to
counseling, they often have had more advice than they can handle. Counseling
operates from the premise that the counselor is knowledgeable about
the change process, but that you are the expert on your life. In some
ways counseling is like working with a coach. You do the work, but by
working with someone who has training and experience with facilitating
positive change, you are likely to work more effectively and see
results more quickly.

Counseling is a last resort: Most of us do not think that we have to
experience a heart attack before we can see a doctor; it is OK to go
if we merely have a sprained ankle. The same applies to counseling -
you don't have to have the emotional equivalent of a heart attack to
see a counselor. By working with a counselor you can often get back on
track much faster and save yourself a lot of unnecessary distress.

Patient Form

Preston Counseling, PLLC

INDIVIDUAL INTAKE

CLIENT’S FULL NAME: _______________________________________________________TODAY’S DATE: _________________

ADDRESS: __________________________________________________________________________________________________

STREET OR P.O. BOX

________________________________________________________________________________________________________________________

CITY STATE ZIP

TELEPHONE: HOME ________________________CELL___________________________WORK ___________________________

AGE: ____________BIRTHDATE: _____________________SSN#: ____________________________________________________

MARITAL STATUS: __________________________ DRIVER’S LICENSE#:______________________________________________

EMPLOYER OR SCHOOL (IF STUDENT): ________________________________________________________________________

Referred by: _______________________________________________Phone:________________________________________

PERSON WHO DOES NOT LIVE WITH YOU TO CONTACT IN AN EMERGENCY:

____________________________________________________________________________________________________________

NAME RELATIONSHIP PHONE

INSURANCE INFORMATION

INSURANCE COMPANY: ____________________________________NAME OF INSURED:_________________________________

INSURED’S SSN#: ________________________________________INSURED’S D.O. B.: _________________________________

INSURED’S POLICY #:_____________________________________INSURED’S GROUP #: ______________________________

INSURED’S EMPLOYER: __________________________________________________AMOUNT OF CO PAYS: ______________

AMOUNT OF DEDUCTIBLE ________________ ANNUAL DEDUCTIBLE MET? YES_________ NO____________

ANNUAL VISIT MAXIMUM ? YES_______________ NO_______________ # OF VISITS?____________________

INSURED’S RELATIONSHIP TO CLIENT:_________________________________________________________________________

AUTHORIZATION #:_________________________________________________________________________________________

IF YOUR COUNSELING IS BEING PAID FOR THROUGH AN EMPLOYEE ASSISTANCE PROGRAM, PLEASE LIST AUTHORIZATION NUMBER AND HOW MANY SESSIONS ARE BEING AUTHORIZED.

EAP COMPANY AUTHORIZATION NUMBER # OF SESSIONS

__________________________________________________________________________________________

To be completed by therapist:

Primary diagnosis____________________ Secondary diagnosis_______________

TREATMENT AGREEMENT:

PLEASE INITIAL:_______________

Co-payments and deductible are due at the time of service. you are responsible for verifying co-payment, deductible and annual visit limits________

I hereby assign payment of insurance benefits directly to preston counseling,pllc. While preston counseling, pllc will bill my insurance company, I will be responsible for any charges incurred if my insurance company does not pay. _________

It is my responsibility to contact my insurance company to obtain the proper authorizations if required. If I fail to do this and charges are denied I will be responsible for all charges. _________

If your portion of the bill is not paid within 90 days from the last date it was incurred a letter will sent giving you 14 days to pay your account or to arrange for a payment plan. iF YOU DO NOT RESPOND you will be sent to collections. ______

A 1% INTEREST WILL BE ADDED TO YOUR PORTION OF THE BILL THAT REMAINS UNPAID AFTER 30 DAYS.____________

FEES ARE $________ for each session. _______

You will be charged $80.00 for missing an appointmenT OR NOT GIVING AT LEAST 24 HOURS PRIOR NOTICE to cancelling an appointment. ________

I have receIVED the treatment agreement AND Disclosure statement i understand and agree to abide by my financial responsibilities. I understand that information will be released to my insurance company, if necessary, and any charges that my insurance company will not cover I am responsible for.

CLIENT SIGNATURE: _________________________________________________DATE: __________________________

To enable My Therapist with accurate and confidential services please complete the following:

Please be aware that Fax transmissions arrive at preston counseling pllc’s OFFICE. confidentiality is maintained with these records, as with all records in our office.

Messages regarding appointments may be left on my VOICE MAIL. _______YES _______NO

EMAIL MAY BE USED TO COMMUNICATE WITH ME. ___YES ___NO EMAIL ADDRESS______________________________

The following individuals may schedule and or confirm appointments.

___________________________________________________________________________________________________________ _____________________________________________________________________________

CONCERNS AND GOALS:

Please describe why you have come in: ________________________________________________________________

_____________________________________________________________________________

Describe goals you want to accomplish by coming here: ____________________________________________

__________________________________________________________________________________________________________________________________________________________

Please CHECK individual items you want to address. Please CIRCLE the two most important, to address first:

Concentration Fears Bowel Trouble Self-esteem

Hopelessness Guilt Stomach Trouble Temper

Depressed Self-control Sexual Problem Relaxation

Harm to self Harm to others Drug Use Finances

Suicidal concerns Impulsivity AlcohoL Use Work

High energy Hyperactive Headaches Motivation

Low energy Attention Difficulties Memory Legal Matters

Anger Sleep Problems Thoughts Career Choices

Temper Dreams Abuse Education

Nervousness Nightmares Trauma Making Decisions

Anxiety Health Problems Shyness Meaninglessness

Stress Appetite/Weight Crying spells Unresolved Grief

Panic Eating/Food trouble Unhappiness Spiritual Concerns

Please CHECK relationship items you want to address. Underline THOSE YOU feel apply to another family member. Please circle the two most important to address first.

Marriage Parenting Recreation Friendships

Separation Children Infidelity/Affairs Holding Other Down

Divorce Housing Physical Fighting Conflicting Schedules

Intimacy Finances Common Interests Problem Solving

In-laws Sexual Desire Showing Appreciation Loneliness

Relatives Agreeing on chores Trusting Each Other Common Goals

Jealousy Sexual Performance Affection Verbal Fighting

Use of time Spouse’s Cleanliness Communication Having Fun Together

HEALTH INFORMATION:

List all current medications: ____________________________________________________________________________

_____________________________________________________________________________

List all current health problems INCLUDING ALLERGIES: __________________________________________________

_____________________________________________________________________________

List past significant health problems: ___________________________________________________________________

_____________________________________________________________________________

Have you been hospitalized OR HAD other psychiatric care related to your mental health? _________

If yes please provide dates and treatment outcome for those events: _________________________________

____________________________________________________________________________________________________________

List previous professional help, AND DATES you received for personal, marital, or family concerns: ________________________________________________________________________________________________

_____________________________________________________________________________

Name of your primary care physician: _______________________May we contact? ______________________

Phone number: ________________________ When were you last seen? ______________________________________

I GIVE MY CONSENT FOR MY THERAPIST TO RELEASE MY RECORD TO MY PRIMARY PHYICIAN SO THAT THEY CAN DISCUSS MY TREATMENT: SIGNED_____________________________DATE______________

I DO NOT GIVE MY CONSENT FOR MY THERAPIST TO RELEASE MY RECORDS TO MY PRIMARY CARE DOCTOR TO DISCUSS MY TREATMENT: SIGNED_____________________________DATE_______________

DRUG AND ALCOHOL ASSESSMENT;

Are drugs or alcohol used by yourself or someone else a significant factor in why you are coming to our office? ________yes ________no

If yes __________self __________other: Relationship_________________________________________________________

ALCOHOL ASSESSMENT:

Frequency of Alcohol use:

_____ Never ______ Less than1 time/month _____ 1-4 times per month _____ 2-3 times per week ______ Daily

Usual Alcohol Consumption:

______ None _______ 1-2 drinks per sitting ______3-4 drinks per sitting ________ 5 or more drinks per sitting

Frequency of use to levels of intoxication:

______ Never ______ less than 1 time/month ______ 1-4 times per month ______ 2-3 times per week ______ Daily

Please describe any alcohol-related problems (e.g. legal, job, physical, or social):_____________________________

____________________________________________________________________________________________________________

Self-perception of alcohol use: (check all that apply) ___ Occasional or social ___ Problem use ___ Psychological dependence ___ Addicted-cannot stop ___ Does not want to stop ___ Motivated to stop

History of treatment attempts: (check all that apply) ___ None ___ Stopped on own ___ Attended AA/ other 12 step program ___ Attended outpatient program ___ Attended inpatient program ___ Attended community-based program

OTHER SUBSTANCE USE ASSESSMENT: (Check Frequency and Duration for each drug used in the last 6 months)

Frequency Duration

Daily Weekly Monthly Less than More than

Or less one year one Year

Marijuana _____ _____ _____ _______ ________

Sedative _____ _____ _____ _______ ________

Stimulant _____ _____ _____ _______ ________

Cocaine _____ _____ _____ _______ ________

Opiates _____ _____ _____ _______ ________

Inhalants _____ _____ _____ _______ ________

Hallucinogens _____ _____ _____ _______ ________

Prescription Drugs _____ _____ _____ _______ ________

Caffeine _____ Number of cups per day ______ Tobacco____ if cigarettes-number per day _______

Please describe any drug-related problems (e.g. legal, job, physical, or social) ________________________________

____________________________________________________________________________________________________________

Self-perception of Drug Use: (check all that apply) ___ Occasional or social ___ Problem use ___ Psychological dependence ___ Addicted-cannot stop ___ Does not want to stop ___ Motivated to stop

History of treatment attempts: (check all that apply) ___ None ___ Stopped on own ___ Attended NA/ other program ___ Attended outpatient program ___ Attended inpatient program ___ Attended community-based program

LEGAL INFORMATION:

Do you have any legal issues? If yes, please explain:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

MARITAL INFORMATION:

Married: ______ Divorced: _______ Living together: _____ SEPARATED: _______ Single: _______ Other: ______

If you checked “Other” please explain: __________________________________________________________________

LIst dates and lengths of any previous marriages: _____________________________________________________

_____________________________________________________________________________

FAMILY HISTORY:

List the names, ages, and relationship, of all persons living in your home:

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________

List the names, and ages of any immediate family members that are not listed above

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________

RELIGOUS INFORMATION:

ARE SPIRITUAL ISSUES OF CONCERN TO YOU ___________YES __________NO

What is your religious affiliation, if any? ______________________________________________________________

Revised 10/28/2005