Laura Umfer, Psy. D., C-MI, C.C.H., SFN, LLC
These calculations are meant to be used in conjunction with the ebook, but they can be used by anyone to help determine your weight goals.
Daily Caloric Needs (DCN):Calories needed to maintain weight. Recalculate every 10-15 pounds. Use inactive to get lowest calories estimated. Calculator below also provides a quick estimate, but they are 50-100 calories lower than what you can really eat.
Basal Metabolic rate (BMR): Calories needed to be healthy. Eating lower than this number will put your body in starvation mode and can make you sick and halt weight loss.
BMI and healthy weight estimates are above. Body Mass Index Calculator (BMI) This is meant to be a guide to determining your healthy weight range. Once you develop more muscle, or are already fit, body fat analysis is more accurate.
Body Fat Percentage I’m giving a link to this one. You’ll see why. There are many ways to measure body mass. Feel free to do an internet search to find others that might work better for you. You also might need someone to help you with the measurements. The calculator below is a good estimate, but using tape and calipers will are better.
Weight Liberator:Contact at 813-385-7974 or email@example.com
For those of you who are unable to work one on one with me for financial reasons or you reside outside of Florida, an ebook is available to help you reach your weight loss goals. Below are some calculators to help you determine necessary numbers needed to lose and maintain your healthy, realistic weight loss goal.
One to One Weight Loss
Losing weight can be challenging, and most of us need support and someone to coach us along. Not only are you transforming your appearance, but your thoughts and feelings about things are transforming as well. This can cause some intense emotions to surface, or issues we have been suppressing might nag at us. While I will be acting as your coach to help you reach your weight loss goals, there will be times that we process issues about how you feel about food. We tend to use food for substitutes for what is missing in our lives, rather than the one thing it is meant for: to nourish us. Unless you come to grips with your food issues, you will continue struggling with your weight and body image. That is where I come in. I am here to UMFERIZE you to overcome the causes and contributors to your food and body image issues. The ultimate goal is to liberate you from your weight and body image issues for good.
I will be there to educate, guide and support you. I will also be available in between sessions via mostly emails if you choose the coaching program, (Phone calls take too much time, and you’d have to wait until I am finished working with other people) to help you. I know how frustrating it is to do one little thing wrong that costs you zero weight loss, and by having contact in between sessions you hopefully don’t have to lose a week or two of weight loss to reach your goal. Keep in mind that the body is complex, and that may happen with a plateau. Patience will be tested, and the rewards are worth it. It is essential that you report your weight and measurements honestly. If you fear the scale, you can close your eyes while I weigh you. There are no guarantees, and the body is complex, and individual results will vary. However; if you follow through with the support and guidance you receive, I am confident you will reach your goals. Since I am a psychologist, there are some things you must be aware of in terms of confidentiality and HIPPA.
Confidentiality is generally protected by law, and I can only release information about you with your written consent. However; there are exceptions; including you being a danger to yourself or others. If you are considering harming yourself, I may be required to seek hospitalization for you or contact a family member to help keep you safe. I may also have to seek hospitalization if your weight or health status makes you a danger to yourself. If you are threatening to harm another, I may have to contact the potential victim or the authorities or seek appropriate hospitalization. I am obligated by law to report all cases of children, elderly or disabled persons being abused.
There may also be instances where I am court ordered to provide information about our work together, although you have the right to prevent me from doing so. However; if you are involved in a court proceeding where your emotional condition is an important element (ex: insanity defense, custody proceedings, suing your psychologist) confidentiality can and likely will be broken.
There may be times when I consult with other professionals about your case, and confidentiality binds these consultations. Basically, I shield your identity when discussing your case with other professionals. Except for consultations, I will first discuss with you any intention to provide information to a third party about our work together. You may be asked to sign a release of information for me to consult with your physician if needed, but you can refuse to do so.
There may be times where we may have spontaneous contact in the community, such as the grocery store, or the mall. To protect your confidentiality and our professional relationship, I will not initiate contact, and I will not be able to engage in any type of social activity with you. Or I’ll just act like I know you and say hello. However, you may choose to initiate contact. My stance is once a client, always a client. Therefore, we will not be able to be friends, date, and work as co-workers, ever. This is to protect you, and I will be happy to discuss this in more detail with you.
Emergency Contact Outside of Therapy
Our relationship is professional, and our contact will be limited to therapeutic sessions, and for weight loss training emails and phone calls as needed. If they become too frequent, I will let you know, and we’ll come up with a solution. In the event of an emergency, such as wanting to hurt yourself, call 911 or 1-(800)-799-7233, unless other arrangements have been made and contracted upon. I frequently check my messages and email, and I will return your calls as soon as possible, but don’t rely on reaching me if you are feeling suicidal or homicidal. If I am away for an extended period of time, I will leave the number of a trusted colleague.
You and I are responsible for honoring our contract, including billing arrangements (See Fees for specifics regarding cancellation and no-show fees). I also expect you to attend scheduled sessions on time and to be prepared to discuss any issues you may want to focus on. You are also responsible for completing tasks you agreed to complete and to bring up any concerns you may have about our contract or our work together. It is ok to tell me something you may think I won’t want to hear. I can handle it. This is one of the times in your life where it really is about you and your needs.
I do not visit my patients’ social media sites, such as facebook, twitter etc., so if you are reaching out for help, I won’t know about it. Please contact me, or call 911 if it is an emergency. You can also call 211 for help and for resources. You can follow me on twitter, but I will not be able to follow you back. I do not link with clients on other sites, such as linked in.com or google+. Hypnotherapy is helpful for weight loss, and you might want to include this at some point. Please know that it is not a magic bullet, and not a substitute for medical treatment, but it can help you reach your goals quicker and easier. We work smart, not hard in my office.
I appreciate your decision to retain me as your weight loss advisor/liberator. The following summarizes my office’s billing practices and certain other terms that will apply to our relationship:
Payment is expected prior to each session. Initial appointments require payment via a credit card of $180.00 for your first session. This can be achieved over the telephone or email, whatever you are more comfortable with. Exceptions can be made, but are not guaranteed. If you don’t have your fee at the time of your appointment, we will reschedule for another time. I refuse to get into situations where people owe money. It puts too much strain on you and our professional relationship. This helps avoid focusing time and energy on finances, and allows us to focus on the reasons you are seeking my services. Subsequent sessions are $150.00. No shows or not canceling within a reasonable time frame (48 hours) will result in being charged the warranted cancellation fee. That will be expected to be paid along with your regular fee in your next session. If I have your credit card information stored, I will bill it at that time. I understand that life happens, but it is not fair to others who want to get into my schedule to no-show or cancel without adequate notice. Your credit card will be charged for any services not covered by insurance, if warranted. You also agree to have relevant information shared with third party payors when warranted.
When establishing fees for services I render, I am guided primarily by the time endured in clinical and academic experiences, in addition to individual needs and financial situations based on each individual’s needs. In determining a reasonable fee for the time and labor required for a particular project, I take into account the skills, time demands, and other factors influencing the professional responsibility required for each matter. My internal allocation of values for my time as well as for my psychological assistant, research assistant, and other personnel changes periodically to account for increases in cost of delivering professional services and other economic factors.
The following applies to individuals who require case management or other forensic services, which may include consultations with third parties you have consented for me to confer with about your case, letters written to attorneys, judges etc. or other matters requiring services in addition to sessions. Services based on hourly rates are applied perspectively, as well as to unbilled time previously expended. My office records and bills time in one-quarter hour (15-minute) increments. Generally telephone calls under 15 minutes will not be billed; however; calls in excess of 15 minutes will be billed accordingly. This will also include email exchanges. Again, this is regarding forensic matters.
In addition to my professional fees, my statements may include out-of-pocket expenses that my office has advanced on behalf of the client or the client’s project. Any additional fees will be expected to be paid by the next session, as it will be added to your usual fee.
Forensic fees will be established on an individual basis. These fees are higher and require a retainer if court testimony is involved. I bill for time spent preparing your report, for depositions and court testimony, even if I never make it to the witness stand, if I spent time preparing, I bill accordingly.
No-shows and cancellations without 48 hour notice will result in a $180.00-300.00 fee being charged, unless other arrangements are made. These fees also apply to anyone with insurance who does not follow the cancellation policy, regardless of what the set insurance fees are.
Fees are subject to change with notice or upon other arrangements.
HIPPA Privacy Notice
It is standard policy to obtain a general written permission to use and disclose your protected health information for treatment, payment or health care operations purposes. You will be asked to sign a Consent form to permit all such uses and disclosures of your information if necessary.
Emergencies. If there is an emergency, I will disclose your protected health information as needed to enable people to care for you. Otherwise you must sign a release to be able to talk to any family, friends etc.
Disclosure to health oversight agencies. I may be legally obligated to disclose protected health information to certain government agencies, including the federal Department of Health and Human Services.
Disclosures to child protection agencies. I will disclose protected health information as needed to comply with state law requiring reports of suspected incidents of child abuse or neglect or elderly persons suspected of abuse.
Other disclosures without written permission. There are other circumstances in which I may be required by law to disclose protected health information without your permission. They include disclosures made:
Pursuant to court order; To public health authorities; To law enforcement officials in some circumstances; To correctional institutions regarding inmates; To federal officials for lawful military or intelligence activities; To coroners, medical examiners and funeral directors; To researchers involved in approved research projects; and As otherwise required by law.
Disclosures with your permission. No other disclosure of protected health information will be made unless you give written Authorization for the specific disclosure.
Your Legal Rights
Right to request confidential communications. You may request that communications to you, such as appointment reminders, bills, or explanations of health benefits be made in a confidential manner.
Right to request restrictions on use and disclosure of your information. You have the right to request restrictions on use of your protected health information for particular purposes, or disclosure of that information to certain third parties. I am not obligated to agree to a requested restriction, but I will consider your request.
Right to revoke a Consent or Authorization. You may revoke a written Consent or Authorization for me to use or disclose your protected health information. The revocation will not affect any previous use or disclosure of your information.
Right to review and copy record. You have the right to see records used to make decisions about you. I will allow you to review your record unless it is determined that it would create a substantial risk of physical harm to you or someone else.
Right to “amend” record. If you believe your records contains an error, you may ask me to amend it. If there is a mistake, a note will be entered in the record to correct the error. If not, you will be told and allowed the opportunity to add a short statement to the record explaining why you believe the record is inaccurate. This information will be included as part of the total record and shared with others if it might affect decisions they make about you.
Right to an accounting. You have the right to an accounting of some disclosures of your protected health information to third parties. This does not include disclosures that you authorize, or disclosures that occur in the context of treatment, payment or health care operations. I will provide an accounting of other disclosures made in the preceding six years.
If requested by law enforcement authorities that are conducting a criminal investigation, I will suspend accounting of disclosures made to them.
Right to a paper copy of this Notice. You have the right to a paper copy of any Notice of Privacy Practices posted on this web site.
How to Exercise Your Rights
Questions about these policies and procedures, requests to exercise individual rights, and complaints should be directed by dialing (813) 385-7974.
By signing this I acknowledge full understanding of my privacy rights. By signing this form, I also agree to and understand the above session and fee terms, and I am making a knowing, voluntary, and willing acknowledgement of the above.I agree to the above policy and to have my credit card charged in the event I forget other form of payment, unless other arrangements are made, or if I fail to show for an appointment or do not cancel in a timely fashion. I have read and understand the benefits and risks of hypnosis outlined in my information packet, (online see FAQ) and understand that this does not replace medical treatment. Should anyone decide to be deceptive and change anything on these forms, (if printed from the internet) I agree that what is on this site and Dr. Umfer’s policy will prevail.
Name: _________________________________ Date:_____________________