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Privacy and Policy

Confidentiality and Privacy Policy

The law protects the relationship between a client and a psychotherapist. Information cannot be disclosed without written permission. However, the following exceptions apply:

  • Any suspected child abuse, dependent adult or elder abuse, for which we are required by law to report to the appropriate authorities.
  • If a client is threatening serious bodily harm to another person/s, we must notify the police and inform the intended victim.
  • If a client intends to harm himself or herself, we will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, we will take further actions without their permission that are provided to us by law in order to ensure their safety. 

Notice of Privacy Practices​

Your Information. Your Rights. Our Responsibilities. 

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review


Your Rights

You have the right to:

  • Get a copy of your paper or electronic medical record
  • Correct your paper or electronic medical record
  • Request confidential communication
  • Ask us to limit the information we share
  • Get a list of those with who, we've shared your information
  • Get a copy of this privacy notice 
  • Choose someone to act for you 
  • File a complaint if you believe your privacy rights have been violated


Please send a message to request a release form for your records.

Name*

Email Address*

Message*

Your Choices 

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help:


Get an electronic or paper copy of your medical record

  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to 
  • We will provide a copy or summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee. 
Ask us to correct your medical record
  • You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. 
  • We may say "no" to your request, but we'll tell you why in writing within 60 days.
Request confidential communications
  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
  • We will say "yes" to all reasonable requests. 
Ask us to limit what we use or share
  • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request if it would affect your care.
  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment in our insurer. We will say "yes" unless a law requires us to share that information.
Get a list of those with whom we've shared information
  • You can ask for a list (accounting) of the times we've shared your health information for six years prior to the date you ask, who we shared it with.
  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures. We'' provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months. 
Get of a copy of this privacy notice
  • You can ask for the paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy.
Choose someone to act for you 
  • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise you rights
  • We will make sure the person has this authority and can act for you before we take any action. 
File a complaint if you feel your rights are violated
  • You can complain if you feel we have violated your rights by contacting us using the information on the home or bottom of this page
  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter
  • We will not retaliate against you for filing a complaint. 
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