Your Rights

• You have the right to receive respectful, non-discriminatory care.

• You have the right to understand your treatment options and ask questions about therapy.

• You have the right to privacy and confidentiality consistent with state law and professional ethics.

• You have the right to decline or discontinue therapy at any time.

Telehealth Rights

• Telehealth services will be provided through a secure, HIPAA-compliant platform to protect your privacy.

• You understand the benefits and limitations of virtual therapy and have the opportunity to ask questions.

Privacy & Confidentiality

Your personal information and therapy discussions are confidential, except in specific circumstances required by law (e.g., imminent harm to self or others, abuse of a minor, court order). A full confidentiality policy is available through your initial intake packet.

No Surprises Act Disclosure

You are receiving services from Alignment Counseling & Therapy on a private-pay basis. I do not bill insurance, and you are responsible for payment at the time of service. You may choose to submit a superbill to your insurance company for possible out-of-network reimbursement. By engaging in private-pay services, you acknowledge and agree that none of the services will be billed to a health plan or third-party payer on your behalf, and you are responsible for all charges incurred.