Confidentiality Statement
Confidentiality Statement
As a licensed therapist in California, I am committed to maintaining the confidentiality of your personal information and the details discussed during our sessions. This confidentiality is a fundamental part of our therapeutic relationship and is protected by law.
Limits to Confidentiality:
1. Mandatory Reporting: I am required by law to report any suspected child abuse, elder abuse, or dependent adult abuse.
2. Threats of Harm: If you express intent to harm yourself or others, I may need to disclose information to ensure safety.
3. Court Orders: If ordered by a court, I may be required to provide information regarding our sessions.
4. Consultation: I may consult with other professionals regarding your treatment, but your identity will remain confidential.
Please feel free to discuss any concerns you have about confidentiality during our sessions. Your trust is paramount, and I strive to create a safe space for your healing and growth.
Notice of Privacy Practices
Notice of Privacy Practices
Informed Consent Statement
Informed Consent Statement
As a licensed therapist, I am committed to providing you with the highest quality of care. This Informed Consent statement outlines the nature of therapy, the therapeutic process, and your rights as a client. By engaging in therapy, you agree to the terms outlined below.
Nature of Therapy
Therapy is a collaborative process that aims to help individuals explore their thoughts, feelings, and behaviors. It may involve discussing personal issues, developing coping strategies, and working towards specific goals. The therapeutic process can evoke a range of emotions, and it is normal to feel discomfort at times.
Confidentiality
Your privacy is of utmost importance. All information shared during sessions is kept confidential, except under the following circumstances:
- If there is a risk of harm to yourself or others.
- In cases of suspected abuse or neglect.
- If required by law or court order.
- If you provide written consent to disclose information.
Client Rights
As a client, you have the right to:
- Be informed about the nature and purpose of therapy.
- Ask questions about the therapeutic process.
- Withdraw consent or discontinue therapy at any time.
- Access your records and request amendments as necessary.
Fees and Payment
Therapy sessions are charged at a rate of [insert fee] per session. Payment is due at the time of service, and you will receive a receipt for your records.
Acknowledgment
By engaging in therapy with [Your Practice Name], you acknowledge that you have read and understood this Informed Consent statement. You agree to the terms outlined herein and consent to participate in the therapeutic process.
If you have any questions or concerns about this statement, please feel free to discuss them during our sessions.
No Surprises Act Statement (Good Faith Estimate)
No Surprises Act Statement (Good Faith Estimate)
As your therapist, I am committed to transparency regarding the costs of your care. Under the No Surprises Act, you have the right to receive a Good Faith Estimate of your expected charges for therapy services. This estimate will include information about the services I provide and the expected costs associated with them.
Important Information:
1. Good Faith Estimate: If you are uninsured or self-paying, you have the right to receive a Good Faith Estimate of your expected charges for therapy services. This estimate will be provided to you within three business days of your request.
2. Out-of-Network Services: If I do not participate in your insurance plan, I will provide you with an estimate of the charges. You should also check with your insurance provider to understand your out-of-network benefits.
3. Unexpected Costs: While I strive to provide you with accurate estimates, you may receive a bill that is higher than the estimate if your treatment needs change. You will be notified as soon as possible if this occurs.
4. Contact for Questions: If you have any questions about your estimate or billing, please feel free to contact me directly.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises . Thank you for choosing me as your therapist. I look forward to supporting you in your journey.
Website Terms of Use
Website Terms of Use
Terms of Use
Effective Date: 03/20/2024
Welcome to Resilient's website. By accessing or using this website, you agree to comply with and be bound by the following Terms of Use. Please read them carefully.
1. Acceptance of Terms
By using this website, you confirm that you have read, understood, and agree to these Terms of Use. If you do not agree, please do not use this site.
2. Use of the Website
You may use this website for lawful purposes and in accordance with these Terms. You agree not to:
- Use the site in any way that violates any applicable federal, state, or local law or regulation.
- Use the site to transmit any advertising or promotional material without our prior written consent.
- Impersonate any person or entity or misrepresent your affiliation with any person or entity.
3. Professional Disclaimer
The information provided on this website is for informational purposes only and is not intended as a substitute for professional advice, diagnosis, or treatment. Always seek the advice of your therapist or other qualified health provider with any questions you may have regarding a mental health condition.
4. Confidentiality
We are committed to maintaining your confidentiality. Any personal information you provide through this website will be protected in accordance with applicable laws and our privacy policy.
5. Intellectual Property
All content on this website, including text, graphics, logos, and images, is the property of [Your Practice Name] or its content suppliers and is protected by copyright and other intellectual property laws. You may not reproduce, distribute, or create derivative works from any content on this site without our express written permission.
6. Links to Other Websites
Our website may contain links to third-party websites. We do not control these sites and are not responsible for their content. We encourage you to review the terms of use and privacy policies of any third-party sites you visit.
7. Limitation of Liability
To the fullest extent permitted by law, [Your Practice Name] shall not be liable for any direct, indirect, incidental, special, consequential, or punitive damages arising from your use of this website or any information or materials obtained from it.
8. Changes to Terms
We may revise these Terms of Use at any time by updating this page. Your continued use of the website after any changes indicates your acceptance of the new terms.
9. Governing Law
These Terms of Use shall be governed by and construed in accordance with the laws of the State of California.
If you have any questions about these Terms of Use, please contact us.