Poling Chan, MSW, LCSW
113 Coronado Court, Building 5, Unit A1
Fort Collins, CO80525
970 481 7397 (Phone)
970 237 3036 (Fax)

                                                                    

Welcome to my psychotherapy practice.  I look forward to working with you.

I am a licensed clinical social worker who specializes in mental health. My approach is body-centered, connecting sensory awareness with mind  in our healing process. I have extensive training in Gestalt Therapy, EMDR (Eye Movement and Desensitization Reprocessing) and Somatic Experiencing. Mindfulness practice skills including those rooted in traditions of yoga and qigong are often incorporated in our work.

I believe I work best with someone who is interested in wellness as opposed to examining pathology. Therefore, my practice focuses on building resources so that you recover your natural ability to heal.

In order for us to have a good working relationship, it is important for you to be fully informed. Please read the following and let me know if you have any concerns or questions.

CONFIDENTIALITY

The information you discuss during a psychotherapy session is protected as confidential under law (CRS 12,43,214 (l)(d)) with certain limitations.

  • I am a mandatory reporter for any suspicion of child abuse to the proper authorities who may then investigate.
  • I may take some action, such as seeking an order for your emergency or involuntary commitment, without your consent if I deem you to be a serious harm to yourself or another person. Any action I take without your consent will be discussed with you.
  • If you file an official complaint or a lawsuit against me, according to Colorado law, your right to confidentiality will be waived.
  • If you choose to use your health benefit, you will have given your insurance company consent to obtain required confidential information for the purpose of determining eligibility for reimbursement. The same applies when you submit a superbill to obtain out-of-network reimbursement.
  • I may seek consultation from another mental health professional. However, your identity will not be revealed without your consent, and your privacy will be protected by that professional.
  • When I am away from my office for an extended period, I may ask another licensed therapist to cover emergencies for me. Generally, I will tell this therapist only what he or she needs to know for an emergency.

AVAILABILITY

You may leave a text or voice mail message during office hours, and I will attempt to return your call within 24 hours during the weekdays or on the first working day following a weekend or holiday. If your support system is not available for you during emergency, please go to the emergency room.

LEGAL MATTERS

My focus of practice is on clinical work. I do not testify or represent any of my clients in court. In order to protect your interests, I do not communicate with attorneys about your record even with your consent.

RECORDS

Treatment record will only be released with your written permission and direction, and if you were seen in couple or family sessions, all adults present would have to sign the releases.  It is my policy to not release an entire record, even with your consent.  Instead, I may summarize the content related to the request.

IN-PERSON VS TELEHEALTH

When you initiate your contact by phone or email, please indicate your preference between in person or telehealth service. Telehealth sessions is advisable if you have any symptoms that are contagious or commute for your appointment is not feasible. In this case, we will send you an invitation link via email /text from doxy.me, a HIPPA compliant platform that ensures confidentiality before your first appointment. Please use the same link for all future sessions.

FEE STRUCTURE

Initial Assessment – 60 min.: $150

Follow up Psychotherapy Session – 55 min.: $130

Follow up Psychotherapy Session – 40 min:  $95

Fee will be prorated if the session extends beyond 60 minutes.

*You are responsible for a co-payment of $______________ according to your insurance plan.

Should third party insurance fail to reimburse your therapist, you will be responsible for the fee.

Payment is expected by cash, check, zelle or venmo at the time when services are rendered. Please check with your insurance regarding your deductible and copayment information prior to first visit. Superbill will be issued upon request in case you are submitting for out-of-network benefits.

*CANCELLATION*

If you need to cancel or reschedule an appointment, please kindly give 24-48  HOURS NOTICE. Any appointment that falls on Monday will require cancellation by Friday before noon.  Failure to do so will result in full payment or the time reserved for you.