Before Your Appointment
Thank you for choosing WellSpring!
The first appointment is considered an assessment. This appointment lasts approximately one hour and 15 minutes. The first 15 minutes is spent processing and completing paperwork. After the paperwork is complete, the client will then meet with the therapist for approximately 1 hour.
What to bring to your first appointment:
- Your insurance card (Molina, CareSource, Amerigroup, Medicaid, Medicare, or Private Insurance)
- If you are a Sliding Fee Client – a copy of 1 month’s worth of paystubs OR a copy of last year’s taxes.
- Payment in full
- A valid photo ID
Please note: Children 14 and under cannot be left in the waiting room by themselves. If the client is a child, then a parent or guardian must be in the waiting room at all times during the client’s appointment with the therapist. No child under the age of 14 may be “dropped off” for their appointment.
Privacy & Client Rights
Client Rights and Grievance Procedure
This client rights and grievance policy will be given to each client at admission, with documentation kept in the client’s record, and the policy will be posted at each program site in a place accessible to clients. All staff will receive and review a copy of the client rights and grievance policy and documentation of staff’s agreement to abide by the policy and procedure will be kept in their personnel files.
All grievances must be written, dated and signed by the client or the person filing the grievance on behalf of the client and should include the date, approximate time, description of the incident and names of the individuals involved in the incident/situation being grieved. Grievances should be given to the Clients Rights Officer, or in the event the client rights officer is not on the premises, the grievance can be given to the Office Manager. Any program supervisor will assist you in filing a grievance upon your request. All grievances, including a copy of the grievance, documentation reflecting the process used and resolution/remedy of the grievance and documentation, if applicable, of extending the time period for resolving the grievance beyond twenty-one (21) calendar days will be kept on file for two years from resolution and will include a copy of the grievance, documentation reflecting the process used and resolution/remedy of the grievance, and, documentation if applicable, of extenuating circumstances for the extending the time period for resolving the grievance beyond twenty-one calendar days.
Within three (3) working days of receiving the grievance program, staff will provide client with written knowledge that includes: a) date the grievance was received, b) summary of the grievance, c) overview of the grievance investigation process, d) timetable for completing the investigation and notification of the resolution, and e) treatment provider contact person’s name, address and telephone number. With twenty-one (21) calendar days of receiving the grievance, the program will make a resolution decision on the grievance. Any exceptions that cause this time period to be extended will be documented in the grievance file and written notification will be given to the client or persons filling grievances on the client’s behalf.
At any time clients or persons filing grievances on the client’s behalf have a right to file a grievance with any of the organizations listed below:
Ohio Department of Mental Health and Addiction Services (OMHAS)
30 East Broad Street, 36th Floor
Columbus, OH 43215
Mental Health and Recovery Board
Of Clark, Greene & Madison Counties
1055 East High Street
Springfield, OH 45505
Ohio Legal Rights Services
50 West Broad Street, Suite 1400
Columbus, OH 43215-5923
Persons who receive mental health treatment services and alcohol and drug addiction treatment services at WellSpring have the following rights:
- The right to be treated with consideration and respect for personal dignity, autonomy and privacy.
- The right to receive services in the least restrictive, feasible environment.
- The right to be informed of one’s one condition.
- The rights to be informed of available program services.
- The right to give consent or to reuse any service, treatment or therapy.
- The right to participate in the development, review and revision of one’s own individualized treatment plan and receive a copy of it.
- The right or freedom from unnecessary or excessive medication, unnecessary physical restraint or seclusion.
- The right to be informed and the right to refuse any unusual or hazardous treatment procedures.
- The right be advised and the right to refuse observation by others by techniques such as one-way vision mirrors, tape recorders, video recorders, television, movies or photographs.
- The right to consult with an independent treatment specialist or legal counsel at one’s own expense.
- The right to confidentiality of communications and personal identifying information within the limitations and requirements for disclosure of client information under state and federal laws and regulations.
- The right to have access to one’s own client record in accordance with program procedures.
- The right to be informed of the reason(s) for terminating participation in a program.
- The right to be informed of the reason for denial of a service.
- The right not to be discriminated against for receiving services on the basis of race, ethnicity, age, color, religion, sex, national origin, disability or HIV infection, whether asymptomatic or symptomatic or AIDS.
- The right to know the cost of services.
- The right to be informed of all clients rights.
- The right to exercise one’s own rights without reprisal.
- The right to file a grievance in accordance with program procedures.
- The right to have oral and written instructions concerning the procedure for filing a grievance.