Registration is only required if you do not have a username. Please check your spam & junk mail folders to ensure you have not already received an email with a username and password. If you already have a username log in here

Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

Please take some time to read over the "legal stuff" here as you register for services with the practice. After your consent is obtained below, you log in and choose services, enter payment method, and schedule. You will be contacted by LaRose shortly after you have registered and scheduled.

Client Information

/ Middle Initial

( optional )
( Must be at least 18 years old )

( for Text Message Reminders )

Emergency Contact

First Name
Last Name
Street Address
ZIP Code

Log in Details

( If client is a minor, the legal guardian must enter their email address below. )

Between 8 and 40 letters and numbers

Challenge Questions

( These will be used to retrieve your password. Answers must be between 4 and 30 characters, cannot contain any spaces. )

( If you feel you must write down your questions in order to remember them, make sure to keep it in a safe place. )

Terms and Policy

Online Information & Consent
The information below contains information about the practice of Kurt LaRose MSW LCSW CHT CSW Supervisor and LICSW for the Secure Client Area @  It is necessary for all users to read, review, and accept these terms to begin services with the practice.  Please know that you are providing the practice with certain consents regarding billing, private health information, and obligations that are contractual and or required by certain standards of care and various mandates that govern mental health, behavioral health, clinical supervision, hypnosis and consultation services - between you and the practice of LaRose.

If you are seeking services with the practice as a NEW PATIENT, CLIENT, INTERN, or PEER, the practice is currently ACCEPTING NEW PATIENTS in for DIGITAL based SESSIONS (Chat, Video, Journal, Secure Email, File Sharing and Phone) for patients  who are SELF PAY.  At this time office face to face and onsite sessions are not offered.  

Specialty services, online options, and hypnosis sessions are offered for residents of Missouri, Washington DC and Florida. All parties seeking services with LaRose are served using multiple formats, however face to face sessions are not offered. Video/chat/telephone/shared journal and narrative digital formats using this secure server are available with asynchronous options available 24 hours a day (replies can be delayed, however generally occur with 24 hours).

New persons/clients will be asked to identify if they are a Florida Resident, a DC Resident or a Missouri Resident upon logging in to this secure server.  A valid ID will be required as an upload, as is a credit card, prior to being able to use the services in the digital server.  At that time the calendar will be available for you to schedule (depending on if your request is a scheduled one or an asynchronous one) after you identify what services you are seeking and your reasons for seeking services.  

Only self pay clients are being seen by the practice of LaRose and all services are available in digital and remote only options.  

Supervision candidates (those seeking licensure supervision will be directed to alternative scheduling platforms after the initial consultation) where online supervision hours can/will occur (if face to face options are not available then supervision services cannot be offered due to licensing board requirements which this can be discussed upon inquiries).


By giving your consent below, you are stating that you are the client and by digitally signing below, you as the legally named party (the client or the medical guardian on behalf of another adult client), agree that you have read this information and that you are providing your legal consent related to each of the following sections:







===> NEWS








REGISTRATION, SECURITY & CONFIDENTIALITY. All client records are stored and maintained via the secure digital profile, thus your site registration is necessary to facilitate and manage electronic health records. Confidentiality, Federal HIPPA and State Privacy Standards, as well as encrypted and password client/therapist communications all make the 2 - 3 minutes to sign up - well worth it.

CONSULTATIONS. Initial sessions are billed to the card on file (unless a special arrangement with LaRose is made or offered/chosen); these can occur by video, by chat, by telephone, secure email and journal options with some services offered synchronously and others asynchronously.

For initial consults clients of MO, DC, and  FL will need to upload their photo ID's and show they may need to show their credit card (for verification purposes of the name and the last 4 digits of the credit card and to establish residency where LaRose is licensed to treat) during the consultation.  

All appointments can be scheduled here in the server, 24 hours a day!  Text reminders of the sessions are sent 24 hours in advance, along with email reminders and a phone message too.  Clients may cancel their sessions in the server PRIOR TO A 24 HOUR WINDOW to avoid a non 24 hour cancellation fee. 

RECORDS STORAGE, CLIENT UPLOADS & REQUIRED CONSENT TO RELEASE. Most people know that mental health professionals gather information related to personal experiences and histories. Private journals, uploading of diagrams, photos, or scanned drawings, and secure emails make the client portal an ideal platform. Encrypted case notes, client notes, insurance information, intake forms and billing records are available for online updates 24 hours a day. Except in specific legal scenarios (safety, court order, regulatory investigations, and in some third party contract terms) your private health information is protected unless/until you give written consent for release. In certain scenarios "privilege" is exercised with your records even with written consent, meaning the information may not be released without properly served subpoena and/or court order when served to LaRose.

AUTOMATIC ELECTRONIC INVOICES & TERMS OF VALIDITY. Electronic invoices email 24 hours before your date of service (or at the starting time of the session). Appointments booked UNDER 24 hours will likely receive an INSTANT electronic invoice.  In all scenarios where services occur, there is billing time associated to that time; if you are unsure of the cost you should ask.  Minute by  minute billing can occur in some instances; in others a flat fee is billed and yet in others there is a one fee for 60 minutes of services.  A balance due is realized (subsequent to any and all electronic invoicing) and if needed the electronic billing will be adjusted at the time costs changes are realized (such as time that runs over or at the time a non 24 hour cancellation has occurred). 

All balances are due at the time of service and/or at the time the fee is realized; balances are billed to the credit card clients provide in the server (the card must be in the name of the client). The  credit card is required upon setting up appointments and in accessing the client portal (credit card data is stored encrypted and cannot be fully accessed by LaRose once you enter it - except to the degree needed to electronically process the credit card and in accordance with credit card storage rules).  Invoices are no longer mailed by traditional USPS mail; electronic copies can be printed in the server at anytime (or printed to a PDF and emailed by clients who choose to do so).  

All amounts due are billed at the current practice rate (see FEES... below for additional information).  

INVOICES AND DISPUTES. Subsequent to any applicable adjustments, if a payment cannot be processed with the credit card on file, a secure email notice will be sent requesting the client update the card to a working card; also a text will be sent requesting an updated card to the cell/texting number your provide (personal email addresses and personal cell phone numbers are required to ensure your privacy).  If a paper invoice must be mailed through the United Postal Service, they are mailed to the clients address as it is/was provided by the client at the time of scheduling (or as updated in the server). Any USPS mailed invoice is due upon receipt. 

Disputes must be noticed to LaRose as soon as they are realized by sending a secure server email (logging into the server) outlining the concerns and the request for resolution.  LaRose does not offer refunds or guarantees as this cannot be ensured in social services and professional talk therapy based services. 

Late payments, unless a financial arrangement is agreed upon and recorded by joint signatures, are reported to credit bureaus (see FEES, THIRD PARTY PAYOR, PAYMENTS, REFUNDS.... for more information).  Credit card payments in the server will prevent time and energy and money in collections, thus the practice will resolve account balances immediately upon the start of all sessions.

FEES, PAYMENTS, REFUNDS, COLLECTIONS, CREDIT BUREAUS and BILLING AGENT. Payments may be made online. All fees and payment terms are discussed here and all questions involving these practices should be discussed during your initial consultation and/or inquiry. 

Clients are encouraged to ask and to discuss any concern they have in this regard as the terms of this agreement is the final word on how such matters are handled and resolved. Fees for the initial consultation will be charged to the card on file at the start of the session or prior to the agreed upon service beginning (usually agreement will be requested in the secure server email platform so that you and LaRose both have a record to access about what is agreed upon). 

The amount you agree to pay or that you are responsible to pay is collected at the time of service. The full hourly rate is currently $155 per hour, unless a group package or specialty service is/has been requested.  Additional service options, special rates, concierge services, and non-specialty services such as hypnosis, minute by minute options with each related fee structure is available at          

In the unlikely event billing agents, collection agencies, credit bureaus and in extreme cases legal counsel are involved to resolve balances, please be aware that the name of the client/person working with LaRose is identified as a client and when necessary it will include the release of the social security number, date of birth, mailing address, ID numbers and phone numbers, as needed to effect collection and to record delinquencies.  These actions are seldom a factor in the practice as outstanding billing seldom occurs in the use of server technologies. Because the practice includes an automated billing and a credit card processing platform collections are seldom necessary, particularly as and when clients/persons working with LaRose keep the credit card profile up to date.  At times LaRose may ask to update a non-working or declined card prior to proceeding in service provisions.

NEWS. All patients and clients who are new to the practice and/or who are considering services with the practice have been notified to read the NEWS tab (click the question mark icon above) regarding actual and anticipated changes involving expanded services, professional biography information, client reviews and various videos related to the practice service and services availability.  Links to these and other relative topics are listed in the NEWS section of the server, and these can be reviewed PRIOR to or AFTER this registration is completed. 

The practice of LaRose is currently accepting new patients/clients who are SELF PAY, and who wish to be seen via remote services, and digital services, including video, chat, and telephone (via this HIPAA compliant secure server); not all session types are available and as such limited service options occur and these change from time to time.  

Florida, DC and Missouri patients/clients/supervisees can access online services 24 hours a day, with digi-mental health services (video/chat/telephone/Shared Journals and Narrative approaches) scheduled based upon calendar availability.  Face to face and onsite scheduling options are not currently available.   

Service options can be selected upon completing the initial registration and based on available service options offered.  Special appointment requests are handled when clients send secure emails (in this server) requesting such (as certain communications cannot occur in a public domain email process).  

In certain scenarios LaRose will schedule an office session however since LaRose is currently 100% online for the private practice this option may not be available due to remote services.  Since the practice is transitioning to a fully digital platform (currently anticipated for an extended and/or possibly an indefinite period of time) and as the services are license regulated to a residents of a three state area (where LaRose is licensed in Missouri, Washington DC and in Florida) creativity and unique digital services options are offered.   

FACE TO FACE and ONLINE INCLUSIONS and EXCLUSIONS DUE TO REGULATIONS. LaRose is licensed to provide traditional talk therapy, clinical hypnosis and clinical supervision services in accordance with the licensing board standards in three jurisdictions, FL, DC and MO.  Digital services, as an emerging area of practice, in both therapy to client and supervisor to supervisee (in licensure scenarios), has benefits and limitations and current regulatory bodies are significantly behind client demands; that is to say that while you may want to access digital services with the practice (such as supervision), you can only access such services if you are an actual resident of the same states where LaRose is licensed to practice in his areas of expertise FOR ONLINE SERVICES and where licensing rules allow for such services.  

Licensing boards in the US do not currently have a universal 50 state credential and licensing fee structure to provider online services across jurisdictions.  If you are resident of MO, DC or FL and you wish to have video/chat/telephone and other online services you may do so at any time.  If face to face services were an option, you could go into the office of the provider (regardless of your residency) and be treated; face to face options are not currently available with the private practice of LaRose.

NON-24 HOUR CANCELLATION POLICY.  LaRose assesses fees for no shows and non-24 hour cancellations (without a documented medical or legal document) when the cancelled spot cannot be filled by someone else. If clients must cancel less than 24 hours, they will have to contact LaRose via secure server email/text as soon as they know they need to miss (if a client text LaRose, they are advised that this is not considered a confidential form of communication and there is a risk of disclosure of information outside of the control of LaRose; use of the secure server is recommended; in urgent matters a text could say "please check the server for an email".   LaRose will have to cancel a session when it is going to be missed with less than 24 hour notice if that is what is requested (online services have fewer cancellations since services can be done remotely) - so clients will have to directly notify LaRose to cancel when it is requested late.  

When appointments or services are cancelled prior to the 24 hour notice window, clients may do so at will in the server, without notification to the office of LaRose - and fees are not assessed.  Clients are encouraged to cancel sessions online as soon as they know they cannot be seen and will be able to do so freely in advance of the 24 hour notice.  LaRose will make every effort to fill a non-24 hour cancelled spot, however except in medical and legal documented scenarios the no show fee is assessed and charged to the card encrypted in the server. 

Cancellations prior to the 24 hour window, are the responsibility of the client, completed by clients using the online scheduling platform in the server.  The fee for non-24 hour cancellations is assessed at a reduced fee of $90 when requested, otherwise the cancellation fee is equivalent to the current hourly fee of $155.  Deposits on hypnosis sessions, onsite services, and preplanned retreats cannot be refunded due to cancellations as numerous hours and scheduling adjustments are made to effect these specialty services. 

Payments, Refunds, Collections. All amounts due via electronic notification are billed until payment is received. At 30 days electronic billing may be transferred to a billing agent for USPS invoicing and collection procedures. The practice of LaRose reserves the right to file any past due amounts with the billing agent, collections agencies, and credit bureaus.  Billing with the practice of LaRose may continue into perpetuity, or until such time as the balance is satisfied, due to the nature of automated online digital technology, or until and as limited by state and federal laws, if applicable.  Use of the credit card platform in the server prevents these steps from needing to be engaged, however, if for some reason a payment is not processed/collected or it is charged back, LaRose will engage the collections process as you (the client) are agreeing to this collections and non-charge back term herein.  

All person's using credit cards to make payment for services agree NOT to pursue charge backs because social service technology and information (therapy, counseling, psycho-education, communication based services and interventions) are non-refundable. In the event a refund is requested (if LaRose denies the refund request), or if a charge back is issued or a stop payment/returned check occurs, the original fees and all subsequent fees as a result chargeback or stop payment actions will remain due (and may increase the overall costs) as the financial responsibility of the client (which you are now agreeing to). 

Charge backs, refund requests, stop payments on checks, returned checks and denied credit card payments will be referred to the billing agent for traditional collection procedures as soon as the office of LaRose is notified of such stop payment actions. If/when necessary the office of LaRose (and the services offered through the Talkifuwant secure portal) are forwarded to credit bureaus; once an account is transferred to a credit bureau, settlement and payment arrangements must be arranged with the appropriate bureau (they are not resolved with the practice once the matter reaches a bureau or collection agency). 

Clients agree that if there is a fee dispute to resolve the matter with the practice.  Because fees are non-refundable, all efforts to stop payments as they are agreed upon here, are referred to collections, based on this agreement.  This is your (the client) agreement to pay for all services as outlined in this initial and online consent, effective for all services rendered for the duration of any amounts due, up to and until payment is received (even in perpetuity in cases where non-payment occurs and in cases where the law permits "in perpetutity" collections).

Billing Agency & Credit Bureau Procedures. A third party billing agency may assist the practice of LaRose with billing practices when USPS services are initiated, and only the information necessary to facilitate billing and collection is released to effect collections. In cases where collections are referred to credit bureaus, the referral is labeled as "professional services" provided to a client name, address, ID information, and social security information (needed at registration in the event of non-payment for the purposes of registering to credit bureaus where default occurs) and the practice of Kurt LaRose MSW LCSW is named as well in the collections process. Credit bureau reporting may have negative financial implications, thus clients are encouraged to determine acceptability of the services offered in the initial consultation. This is your (the client) agreement to pay for all of the costs for the services incurred by you (up to and including any costs added during a collections process). 

Hardship Fee Reduction Agreements and Discount Options for Fees.  If, after starting services with the practice, clients experience a hardship, and you (client) cannot afford the services provided by the practice, due to an inability to pay, reduced fee agreements can be requested based upon verifiable income, verifiable hardship, and a credit report requested by the practice on your behalf.  Hardships can and do occur in the course of therapy, and when documented and evidenced, the interruption of care is NOT recommended; it is in these scenarios where fee reduction agreements become an option.  

Clients who wish to obtain a discounted fee, not as a hardship but as an option in the bundling of services, are able to obtain a lower rate if they pre-purchase set numbers of sessions or packages (see for the breakdown of packages) and when prepayment occurs.  These discounted packages are a "use it or lose it" package; for example, if clients purchase 24 sessions for a calendar year with a discounted prepayment fee and the client only uses 20 of them, the remaining 4 sessions expire at the end of the 12 month term. 

ACCOUNT ADJUSTMENTS. Credits and debits will be made electronically as they are realized to the client online secure billing profile, and any adjustments will be explained in a secure email in the server to the client. Any credit posted to the digital billing profile where a credit on the account balance is realized (in the event of automated electronic billing errors or when an over payment occurs) are refunded upon request of the client (or when realized by the practice using the card that was used at the time of the fees were assessed). In some cases the credit cannot be applied to a card on file (for a number of scenarios related to the merchant account and the server gateway) and in such cases a paper check will be mailed to the address on file in the secure server. The digital billing profile is accessible in the secure client area of the website - 24 hours a day and clients agree to check the billing profile once notifications of fees and credits occurs; clients may elect to make payments (by clicking one button) in the billing profile and it is in the billing profile invoices and receipts can be printed by clients.

MENTAL HEALTH ONLINE, SAFETY & 911, LICENSING, and MALICIOUS BREACH. Online communications in mental health service delivery is considered a non-traditional form of service. National Professional standards, specific legal limitations, and matters involving aspects of online communication that are not a factor in face-to-face sessions require consent.  Clients using such services acknowledge that these services are still, in 2021, considered non-traditional.  Confidentiality, for example, in a digital based session cannot be managed ONLY by the therapist; clients assume a responsibility in ensuring their own confidentiality during video/chat/telephone/secure email/shared journaling, and by NOT sharing their user names and passwords related to the secure server.  Other examples include the difficulty in determining safety if/when a video or chat session is interrupted (either by the client or by an act outside the control of the client and LaRose) and if in the course of a session safety risks are realized and cannot be determined in real time wellness checks are used to determine client safety (a wellness check involves having law enforcement visually determine if a questioned safety concern is resolved).  Further, in chat sessions (or all other digital mental health services) it can be difficult to accurately read a situation with a client since the client is NOT face to face with the therapist.  Innuendo related to violence by journals and secure emails are strongly discouraged as asynchronous informational access (time lapses between the time it is recorded and when it is reviewed) may require immediate response time once a possible risk of harm is realized.  

Online mental healthcare is a specialty practice.  LaRose has self published on the online digital services model in 2012, and was using digital mental health options before state, national, and association language addressing such uses were yet created (prior to 2012).  LaRose has been a National Association of Social Workers Florida State Lead Presenter on the topic of digital mental health services in 2016.  Additionally LaRose is heavily involved in consulting other online platforms in expanding the technology to other providers and other services (such as peer to peer online consults for licensing and situational collaborative interventions).  

Clients using digi-mental health are generally aware (less and less so given streamlining that resulted during the 2020-2021 pandemic) that digital services, particularly mental health, continues to be considered a non-traditional service.  As such, journaling, emailing, file sharing, even in the end to end encryption platform remains on the cutting edge of social services technology.  To date, the server has not been hacked; however the DOD, the IRS, BCBS, the DNC and other organizations of paramount security expertise have been.  It is imperative for users to know that the risk of such a hacking occurrence is expressly noted and acknowledged.  If such a "hack" were to occur the law requires that users be notified.    HIPAA laws and rules govern the access of private health information and licensing standards govern the disclosure of peer to peer consultative information, when such events occur; this practice complies with the notification, sentinel events recording of, and corrections policies.  The practice has not experienced hacking since its implementation of the secure digital server in 2012.  The services with LaRose, as they are stored and recorded, used and accessed in the server are all HIPAA compliant in security (not all platforms for video, chat, are HIPAA compliant).  

Use of Government and Business Email Accounts and Sharing of Server Usernames and Passwords.  Clients agree NOT TO DISCLOSE or SHARE THEIR SERVER USERNAME AND PASSWORD WITH ANY OTHER PARTY.  Clients agree to use their personal email address for communications with the practice of LaRose and in registering for services with the practice (clients should not use government email addresses and unless self-employed and controlling your own email account, clients should not use company based email addresses when registering and working with the practice).

Safety. Persons who are aware that safety is a relevant consideration in their mental health history (past or present) are encouraged to contact a mental health professional via telephone, rather than via online methods. Where safety concerns are compelling, users should contact 911 (24 hours a day), text 741-741 (or see the page). Safety threats via online communications may require quicker response times (particularly in cases where clients disconnect without consensus) to ensure client and other well being.  Matters of safety such as child and elder abuse, actual and imminent threats of harm, suicide and homicide risks are all assessed when/if these are reported by clients or suspected by LaRose.  Confidentiality standards, that is the release of protected health information and mental health records laws, are superseded by safety laws and standards of care.  That is to say, clients are advised and agree they are aware that in matters of safety risk determinations these matters are of a mandated reporting standard, and as such are reported to the appropriate regulatory and enforcement body.  While mandated reporting is often confidential from those who make such reports, it is USUALLY (not always) the practice of LaRose to explain the reporting and to assist clients in dealing with services that are provided outside the scope of the practice; mandated reports are not handled by the practice (only reported when the scenario is evident and/or reasonably suspected by the practice), as such the interventions and legal steps taken by the receiving party of the mandated report is handled and resolved between the client and the agency who handles such reports.   It is common during the course of mandated reporting for other information to be disclosed to the receiving agency - over and above the harm or risk of harm, such as diagnosis information, disability information, concerns about weapons, location of the client, etc.  It is also common for follow-up communications to occur between the receiving agency and the practice.  The exception to confidentiality is explained here to inform clients of other ways health and session related information could be shared, when/if safety risks are evident.

Confidentiality and Release of Records.  Mental health providers cannot acknowledge or deny knowing a client under any circumstances (outside of safety) without a written specific consent that explains what information is being shared, why it is being requested, if it is denied by the client what impact such denial may have on care, and how long the release is permitted.  Mental health providers cannot talk to family members, friends, or other providers about a client without written consent.  Likewise the practice of LaRose cannot obtain other provider information about a client, without written consent.  If another provider, based on client consent, releases information to LaRose, those 'other provider' records are scanned into the client digital file, after review, and the client is notified of such receipt and review in the secure server.  Those records can be discussed.  Providers cannot forward the records of another provider, even with client consent, and even if those records are scanned into the server.  Each provider must generate their own records and clients wishing for all records to be forwarded to a certain provider would need to sign a HIPAA compliant release for each provider to do so.  In the case of court orders, or subpoenas, the practice of LaRose must respond to properly served subpoenas and will do so.  Even with subpoenas clients are notified of the subpoena and they are asked if they would like to review the records that are court ordered, prior to a release (even if the subpoena is from the clients own attorney).  Clients have a right to review their records and they have a right to request that any errors be corrected; in the case where a client disagrees with the record (that is it is not factually or clinically in error) the client has a right to include a statement of their disagreement into their medical records, and the practice of LaRose will include such disagreements in the record to reflect the client notice.  Notification of a correction/error/disagreement can be made in the secure server, at the time it is realized, and LaRose will respond to the notice within a 14 day period (often within a day or two, due to speed of digital records storage, retrieval and generation).  Some records, those that are deemed to be the property of the provider, not the client, can be withheld in released records.  Usually, when a records request occurs, the entire file (excluding shared file attachments - as these are recorded and explained in all session notes) is generated, including treatment plans, progress notes, general notes, secure emails, shared journals, and all legal consent documents.

Licensing. Florida, DC and Missouri licensing allows online sessions with residents of the state; out of state online requests, at least in the current evolution of social communications technology, is not yet standardized and is not permitted.  Online clients will be asked to show a valid government issued ID with their picture, DOB, and address on the screen (and to upload an image of such in the secure server by clicking the attachment options when prompted) at the time of or prior to online services.  This is done to ensure that LaRose is NOT treating clients online, outside of the jurisdictions where he is licensed.  Residents of Florida, Missouri and DC who are traveling out of the state, can continue to be seen digitally, as long as they continue to be active residents while travelling (an added plus to online options).  US wide services generally cannot be provided (state licensing standards rule) online at this time as standards of care and regulatory bodies remain behind the current trends in social service digital mental health provisions of services.  All clients, regardless of residency, can be seen in face to face sessions with LaRose in DC, FL and MO by appointment only IF the office scheduling option is available. 

Malicious Breach. I (the client) agree that in the unlikely event of a breach of confidentiality involving encrypted/secure online communications occurs, it will be deemed a malicious and intentional act by the office of LaRose and and the secure server linked to (the secure client area). Upon awareness or suspicion that such acts are occurring, I understand that LaRose will contact the appropriate law enforcement authorities while releasing all information necessary to facilitate their investigation. I agree to cooperate fully with any law enforcement agency investigating a malicious confidentiality breach.  I (the client) agree that I will not attempt to breach any areas of the server during the course of my care; I understand that at anytime I may be blocked if/when suspicious behavior is recognized by the server.

Server and Practice Access.  Clients agree that while they have full 24 hour access  to online service options in the server, the server remains as the digital practice of LaRose.  As such, clients agree that LaRose, with or without notice, may limit or block client access to services in the server due to non-payment, verbal aggression that cannot be regulated by interventions (as in repeated requests and problem solving that does not cause verbal aggression to cease), misuse of any of the online services, including excessive scheduling and cancelling of appointments (as in taking more than the intended number of sessions simply to hold a spot and then later cancelling, excessively), or in the case of any other cause that LaRose may explicate by secure email in the server.

ONLINE AND SOCIAL MEDIA PRESENCE, CLIENT REVIEWS AND DIGITAL ETHICS DISCLOSURES. For more information on the developing standards in online social services communication, users may want to view ==>  

It is important that clients (you) understand that the HIPAA secure digital server as explained above and elsewhere is NOT THE SAME THING AS DIGITAL SOCIAL MEDIA PLATFORMS (Skype is a social media - non HIPAA secure platform; Facebook, Instagram, Twitter, and the like are social media platforms).  In November of 2017 the National Association of Social Workers advanced and developed its social media and digital online policy statements in its national code of ethics.  The most recent governing protocols for the practice of LaRose can be found at: (see code of ethics) and on the TalkifUwant website their is a drop down to access practice policy statements and uses in social media.  

Clients using other digital platforms (social media), outside of the practice secure server (which is NOT social media), relating to the practice in any way, may run the risk of identifying themselves as a patient/client.  Users should use caution in other non-secure platforms.  LaRose maintains a large social presence on Twitter, Facebook, Linkedin, Instagram (and a myriad of other platforms). Users may access LaRose via other social medial platforms ONLY IN THE PROFESSIONAL ONES USED BY LAROSE; professionally practice related content is available using the #TalkifUwant.  Personal access is not permitted between clients and LaRose thus any link requests where such is known to be with a client and LaRose in a personal platform - will be refused by LaRose at the personal level.  Professional contacts @talkifuwant are okay, however disclosures of self as a client is NOT recommended.  Client reviews of the services by LaRose are encouraged (google reviews, healthgrades, yelp, etc.), however clients are not required to do so and many can be done confidentially.  

Online reviews increasingly provide the tools by which providers using online social services models found by others seeking similar services.  Please keep the practice in mind when/if you make referrals, as you consider using these services, and whether that by online reviews or direct person to person suggestions is something you are comfortable with.  Reviews and referrals should be done anonymously; that is without identifying yourself by name.  LaRose cannot acknowledge or deny seeing a person without written consent, thus if a referral is made LaRose will not identify the referring party as a patient/client. 

Social Media Policy, Patient Bill of Rights and Privacy Practices.  You the client acknowledge that you have reviewed and that you have been able to download and print from the website the following:

Social Media Policy:

Patient Bill of Rights:

Privacy Practices:

This secure server is NOT social media.  No other party, besides LaRose and office personnel that may be needed to effect your care/services (if they are involved at all), can access your file in this secure HIPAA compliant platform.  Emailing, journaling and all records are encrypted, end to end (from therapist to client and from client to therapist) ONLY.  Users of this platform cannot cross communicate or access each others information as the server is a client by client secure file within the online secure server of the practice.

ONSITE SERVICES, ON LOCATION SERVICES, SUPERVISION, PROVIDER DEVELOPMENT, CONCIERGE AND ANNUAL RETREAT SERVICES.  The practice of LaRose offers and provides various non-traditional behavioral health, mental health, coaching, hypnosis, consultation and retreat type services, in addition to the online video/chat/journaling sessions and may at some times offer traditional face to face options (face to face options are not currently available). These expanded services allow for remote counseling program implementation, remote supervision and licensee consultation, in and out of state therapy/education based retreats and get aways, provider practice set up services each unique and customized to the needs and demands of clients, peers, supervisees and institutional based services.  

This agreement provides for an overview of the practice involving billing, records, the use of the digital server and general cancellation matters.  Specific terms are provided subsequent to this initial consent and server portal set up process, related to the specific requests of the user, as fitting and appropriate to your situation. It is disclosed here, that in addition to these terms, other contract terms may be added later, to accommodate the specific and unique requests of other parties involving onsite services, hypnosis and coaching services, retreat services, supervision services and provider set up services.  If and when your situation requires an addendum contract or an alternative contract subsequent to this portal registration, this will be discussed in your initial consult.  

Upon registering and logging in you will choose what service you are seeking from the practice (and you can choose multiple services) which will be reviewed and discussed during the initial consultation.  If there are questions due to data entry errors, confusing answers or possible changes that have not been globally updated in the digital platform, after you register here, LaRose may call or text prior to your services being initiated.  LaRose may elect to cancel scheduled services until the confusion is resolved (if one is realized during the online "onboarding" process) that is currently underway.

ANNUAL RENEWAL FOR BILLING PRACTICES, HIPAA, AND POLICY UPDATES AUTHORIZED BY USERS. This authorization will be renewed annually via annual forms that are required upon server log ins the first month of every calendar year and/or as changes may be needed/required. This summary will be incorporated into the new year policy changes and updates, where clients must provide new authorizations for billing, updated contact and emergency contact information, and annual renewals of privacy statement updated regarding protected health information. These updates mean that new clients may be required to complete an initial authorization, and an "updated one" due to automation limitations.  Clients agree that this and any other subsequent authorization and information regarding protected health information is available to be printed out in the server, at the time it is completed, and/or the client acknowledges that a copy of such documents can be requested and printed out in the server.  Each years forms, as updated, are incorporated herein - thus this document and the updated yearly renewal forms reciprocally reference each other (necessary for ongoing authorizations). Example: this form is the initial required agreement between you and the practice for all services, however, every year various rules, laws, contract terms, and standards of care/practice require renewed authorizations (both forms are active from year to year, as these occur). Any revisions to billing practices, collections, health information standards etc. etc. are referenced in the newest renewal forms that clients will be required to complete each year, after logging in.  Each form as it is updated, includes an update chronology sequence on the form itself. 


CL & TXT: 850.545.2886
EM: (non secure emails are not replied to here; use of the secure email platform is recommended)

| LicensedClinical Social Worker | Credentialed in Clinical Hypnosis | CSW Qualified Supervisor | Licensed Independent Clinical Social Worker |

Florida License: SW9297

Washington DC License: LC50081569

Missouri License: 2020023042

Initial Online Information & Consent Revision History: 02/2012, 12/30/2012, 10/16/2014, 06/15/2015, 6/26/2017, 11/02/2017, 12/12/17; 4/13/18; 4/26/18; 7/11/18; 2/10/21; 10/28/21

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Practice Information, Extension of terms each year, and Changes
In new calendar years, there are changes that take place that may/will impact services with the practice; however, many aspects of the practice are not affected by these changes. This document explains the changes, as appropriate, and incorporates other agreements, as previously signed between you and the practice of Kurt LaRose MSW LCSW LICSW. Please take a moment to review, agree, and accept these changes, as summarized here. The terms "I, me, my" reference you as the client. The terms "the practice, the office, Kurt LaRose MSW LCSW, Kurt LaRose MSW LCSW LICSW, LaRose" reference the office and practice of Kurt LaRose MSW LCSW LICSW (and the affiliated assignees who partner with the practice to effect care). 

History, updates and changes to be aware of and to agree to:   

1) In February 2012 the practice of Kurt LaRose MSW LCSW initiated electronic health records compliance and added the digital secure server for client side 24 hour online access; the updates and changes listed here, incorporate and extend the "Initial Online Information & Consent" practice terms, policies, and procedures as they were included at that time, with modifications as noted in the chronological dating sequence, where and when updates and modifications were deemed necessary.  "Deemed necessary" relates to the ever changing health care industry, third party payor complexities, changing rules, regulations, and laws, practice protocol changes (ie: new forms, updated contact information, etc), changes in the professional services fee structures (ie: moving from an insurance based model to a self pay), developing specializations such as hypnosis credentialing in Florida and adding licensing credentials in the District of Columbia and again in Missouri, along with adding non-traditional services (ie: video sessions, chat sessions, journal exchange digi-therapy, 24 hour online practice feature accessibility, etc.).

You, the client, are asked to review and agreement of this digital document (titled "Updated Practice Information Extension and Changes" digital document), which was added subsequent to the 2012 initial policies, and you are stating:

I (client) am agreeing to the "Initial Online Information & Consent" terms and I am agreeing to the subsequent changes here (and in other updated terms that may be required each year). With my agreement, effective with my digital signature and acceptance, I consent to the these terms and as applicable this annual update.

1) I understand that the practice of LaRose provides online digital mental health services for Florida, Washington DC and Missouri residents and that as of December 2020 face to face options were discontinued; all services are now offered remotely for the Private Practice of LaRose.

2) All agreed upon terms between me and the practice are digitally signed and stored in the secure server. Agreements can be accessed, reviewed, and printed at any time by clicking on the FORMS icon, after logging into the secure client area. By logging into the secure server, and clicking on the FORMS icon, I am acknowledging that I have received a copy of this (and the other) agreements, as digitally signed by me.

3) LaRose is accepting new patients who were/are SELF PAY. This change currently affects all patients. 

4) I agree to pay the fees as soon as I am notified that an amount is due. I also agree and understand that any balances due will be and can be located in the secure server by clicking the BILLING icon and I understand and agree that I can make payments online 24 hours a day. I agree that, by providing my credit card information, I am giving consent for the practice to bill that card (encrypted by federal credit card storage mandates) for any and all incurred fees including non24 hour cancellations.

5) I agree to review and update the "My Info" section in my digital profile (see the gear Icon after logging in) with my current mailing and billing address and phone number(s) where I can be contacted, when and as changes occur.  I also agree I will keep this information current upon any return appointments to the practice, where time lapses between care have occurred.

6)  I agree and understand that if I am NOT a legal resident of Missouri, Washington DC or Florida (where LaRose is licensed to practice) that I will not schedule or ask to be seen (online) since online services in mental health are regulated to residents and licensee locations.

7) I understand that with every new calendar year, and upon logging in, I will be prompted to provide updated billing information, updated authorizations, a copy of my photo ID showing my legal residency, and to renew any and all prior agreed to policies that are still in effect from the prior year (where prior year services exist) as a condition for ongoing services. This document (and others like it), incorporate initial online consent terms from prior years as/if applicable, and it is the prompt requesting me to provide current and updated information with renewed consents as they are generated here (and as they become realized and needed).

8) I understand that a current copy of these terms, as they are saved in their original signed format can be printed after I log in to the server - and that these copies are my copy - accessible any time in the server 24 hours a day.  Only the current or most recent terms may be available, once the prior expired terms are "replaced" or updated.  I understand that at the time I am digitally agreeing to these and other terms I can (and have been advised to) print a copy so that a copy can be saved by me.

9) I agree and understand that as policy changes occur, a revision note will be made under a 'revision history' heading, that includes the prior dates of the policy and each date that the policy is/has been modified (knowing that only my original signed version is the one that can be printed). I agree that these changes will occur with or without notice to me in advance (except as already noted in the new calendar year clauses above).

10) HIPAA limits what information can be shared regarding my health information by mental health providers. This "Practice Information, Extension of terms each year, and Changes" document also serves as my authorization (or if I am a current client of the practice it is my re-authorization) for the practice to take steps necessary to bill me and to use gateways of processing payments (and collections of payments) including my consent for the practice to share with the payor(s) their required information involving my legally protected health information - up to the degree necessary to obtain payment.

11) HIPAA regulates or provides information regarding text messaging of health information - including appointment times with a mental health provider. I agree here, that the Practice may notify me of appointments and other related information involving my session appointment times by text message, voicemail and/or email - using the phone number and contact information I have / will provide in the server.


-I understand and agree that the practice of LaRose, effective November of 2017 is accepting clients who are SELF PAY.  I acknowledge that I have been informed that the practice is a self pay practice, as it is publicly posted on the talkifuwant domain, with google, healthgrades, psychology today and other publicly accessible sites.  I understand and agree that it is possible that LaRose is listed as a provider on a network by an insurance carrier site, as the carrier has yet to update their panel listings and/or website data banks are not current.  

- Because LaRose has terminated all private practice insurance related contracts I am aware and agree that I am going to utilize the services (explained here) I am paying for these services directly and out of my own pocket.  

- In instances where LaRose may be listed as an in network provider with carriers (effective in late 2020 and early 2021) I understand that those carriers are not related to services provided by LaRose in his private practice and that LaRose may be listed as a provider due to an outpatient mental healthcare clinic and hospital professional relationship (those services are provided by the terms of the hospital, separately for the private practice of LaRose.  Here, in the private practice of LaRose, LaRose does not accept insurance as an in network provider.

-In the self pay model, clients have more diversity in services and treatment options, they can now use supplemental digital services (for those who enjoy encrypted asynchronous communication in the client portal between sessions).  Asynchronous services are billed at the hourly fee - and divided into minute by minute timing (read and reply time) as clients share information in the server and as clients request replies, reviews, comments, and feedback.  I (the client) agree and understand that these fees are billed to my credit card on file at the time of the read and replies.  These services are available to clients 24 hours a day and replies are often generated in 24 hours or less.

-Self scheduling in the digital server allows for faster recovery times (and increased motivation for patients who seek care here) and is accessible 24 hours a day in the secure server.  In the event clients wish to have regular and different times opened up on the self scheduling calendar (after an initial consultation is completed) clients may request special time slots via secure email and if available these times will be reserved specifically. 

-Discount options exist because the practice is not affiliated with any third party payors and it does not operate "in network" with health insurance companies (providers who do may not discount fees as this can violate third party payor contracts).  If clients wish to take advantage of a session fee discount by purchasing 10 or more sessions in advance, this option can be arranged here in the server (or it can be set up later via secure email).  

-Reduced fee options exist because the practice is not affiliated with third party payors and it does not operate "in network" with health insurance companies (providers who do so may not be permitted to offer reduced fees particularly if accepting federal policies).  If clients begin therapy sessions here and after the first several sessions (after the 4th one, excluding the initial consultation) clients find the costs of care are too high or prohibitive in completing care they/clients may ask about reduced fee agreements.  Reduced fee agreements are not common, however, these are preferred over ending services prematurely, may be needed in major life events, and are available to those who do not have any health insurance alternatives.  Restrictions apply with reduced fee agreements, which will and can be discussed at the time it is believed that care will be impacted by fees (and or major life events).  

-LaRose ended insurance in network status after excessive delays of payment and multi-variate changes with each carrier and after a chaotic time management quagmire (the practice was at 2.82 hours in insurance collections process time to each one hour of patient care between three team members, when the decision to end participation was made - in 2017).  

- If I have health insurance with out of network benefits I acknowledge that I am responsible for/to contact my insurance carrier to ask them if they will issue the re-imbursement if I elect to submit my own claims to my carrier.  

-I understand that I am responsible for all fees billed as I request various services and that these fees will be explained to me in the course of services access, and that they are non-refundable.

Updated Practice Information Extension and Changes Revision History: 01/04/2013, 10/16/2014; 12/29/2014; 06/15/2015; 6/26/2017; 11/02/2017; 7/11/2018; 5/24/2019; 2/10/21; 10/28/21

Please indicate your agreement to the above terms, as indicated above.

- Licensed Independent Clinical Social Worker| Licensed Clinical Social Worker| Credentialed in Clinical Hypnosis | CSW Qualified Supervisor -

| Missouri Lic. 2020023042 | DC Lic. LC50081569 | Florida Lic. SW9297 | 

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No Surprises Act and Good Faith Estimates Notice

As of January 1, 2022, under rules related to the No Surprises Act, providers of healthcare (and facilities of healthcare) are required to notify patients of specific cost estimates (good faith estimates) to all patients (currently in care and/or new to care).  There are specific timelines that providers have to act to be in compliance (in general January 1 was/is the deadline); and there are specific timelines of notices that must be given to every patient who uses services.  This required update in the practice of LaRose Terms and Policy is intended to fully disclose the rules and the costs of care to you (patients of the practice) and it is an extended effort to additionally ensure that you do not experience  "surprise billing" for any and all services you request and receive while working with LaRose and this practice.  

The Practice of LaRose discloses all costs for services on the website and has engaged in the full disclosure of costs since first opening in 2005.  Additionally fees, cancellation charges, and billing processes are reviewed and consent in writing is obtained from all patients prior to being able to schedule. All patients to the practice, since the practice opened, also agree in writing that they have been informed of the costs of services.  With the electronic server, implemented in 2012, all fees are instantly invoiced with patients electronically at the time a patient schedules any/every service they seek. With the uses of the server, all invoices for scheduled services are generated 24 hours prior to schedule service taking place. While these disclosures, consents and ethical standards are a part of the normal course of business and care with this practice (and even as these have been true for the practice since opening) the No Surprises act requires providers (LCSW's in private practice are included) to generate Good Faith Estimates.

The following notice is copied, using a CMS (the Centers for Medicare and Medicaid) template, as an effort to formally meet the requirements of the No Surprises Act.  All patients are asked to read and indicate that they have been informed of their rights and the rules in this regard:

You have the right to receive a "Good Faith Estimate" explaining how much your health care will cost

Under the law, health care providers need to give patients who don't have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.  

You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.  

The Practice of LaRose provides talk therapy (counseling), coaching, consulting and supervision based services; medications and equipment are not provided by this practice.  "Medical tests," if these were to be recommended by LaRose would likely be in the form of survey type assessments/questionnaires, on paper or electronic. If tests are suggested the costs to the practice are provided as "pass through fees" to patients, meaning whatever the fee the vendor charges the practice for their testing would be disclosed to you prior to your election (or declining) use of the survey/assessment/questionnaire.   

If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. 

You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the healthcare provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask. If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.

The practice of LaRose generates Good Faith Estimates electronically and automatically for every patient who logs into the server to schedule appointments.  In that process, electronically, you will be required to choose your service options and the full estimated cost for the following 12 months will be generated - and - you will be required to electronically sign the Good Faith Estimate.  

Make sure to save a copy or picture of your Good Faith Estimate and the bill.

For questions or more information about your right to a Good Faith Estimate, visit, email, or call 1-800-985-3059.

PRIVACY ACT STATEMENT: CMS is authorized to collect the information on this form and any supporting documentation under section 2799B-7 of the Public Health Service Act, as added by section 112 of the No Surprises Act, title I of Division BB of the Consolidated Appropriations Act, 2021 (Pub. L. 116-260). We need the information on the form to process your request to initiate a payment dispute, verify the eligibility of your dispute for the PPDR process, and to determine whether any conflict of interest exists with the independent dispute resolution entity selected to decide your dispute. The information may also be used to: (1) support a decision on your dispute; (2) support the ongoing operation and oversight of the PPDR program; (3) evaluate selected IDR entity's compliance with program rules. Providing the requested information is voluntary. But failing to provide it may delay or prevent processing of your dispute, or it could cause your dispute to be decided in favor of the provider or facility.

By entering your electronic signature below, you are agreeing that you have been advised of the obligation of the practice to generate and to inform you of your right to receive a Good Faith Estimate.  This agreement / signature does not mean that you have been provided the Good Faith Estimate, as the estimate will be generated based on services selections in another digital form (filled out later).

I agree, by entering my electronic (typed) signature that the practice of LaRose has provided me information about my rights involving Good Faith Estimates.  I also understand that I can print a copy of this agreement after it is completed and/or request a copy of this agreement from the practice after it is completed.

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