Policies

[Wisdom Within Counseling, LLC. Marriage and Family Therapy. 8 W Main St. 3-15. Niantic, CT 06357. 860- 451-9364. www.WisdomWithinCT.com]

INFORMED CONSENT FOR PSYCHOTHERAPY AND COACHING

GENERAL INFORMATION

The therapeutic or coaching relationship is unique in that it is a highly personal and at the same time, a contractual agreement. Given this, it is important for therapist/coach and client to reach a clear understanding about how the relationship will work, and what each of us can expect. This consent will provide a clear framework for therapeutic work together. Clinical interns are private pay only. Clinical interns are also not insurance reimbursable. We have both out of network and private pay therapists. WWC has a firm 48 hour late cancellation policy.

WWC requires 48 hours notice to cancel or reschedule all appointments after the intake.

WWC holds appointment times for you, as the client, and therefore other clients are told they cannot receive appointment at the time reserved for you. When 48 hours notice is provided, WWC can then offer that appointment time to another client. The full fee is late cancellation fee when 48 hours notice is not provided. Sessions are available via video, phone, or in person in Niantic, Connecticut. The system will 72 hour appointment reminders automatically as a curtsey. I understand I need to text, call or email my therapist directly to cancel or reschedule.

THE THERAPY OR COACHING PROCESS

The outcome of your treatment depends largely on your willingness to engage in this process, which may, at times, result in considerable discomfort. Remembering unpleasant events and becoming aware of feelings attached to those events can bring on strong feelings of anger, depression, anxiety, etc. There are no miracle cures. I understand therapy will not cure me or fix me. I understand WWC cannot promise that my behavior or circumstance will change. WWC can promise to support me and I will do my very best by my commitment to the process. Upon intake session, a WWC therapist will do a treatment plan and diagnose me unless I tell WWC not to before the intake. Upon signing this consent document, I sign off on my treatment plan, that is signed only by their WWC therapist.

FREE FROM SUBSTANCES AND ALCOHOL

I will, under no circumstance, attend a counseling or coaching session under the influence of substances or alcohol. To get the most out of counseling, I know that my sobriety and my commitment to clear thinking in session allows me and my therapist to get the most out of counseling. If my therapist thinks that I might be high or too medicated to receive counseling, or using alcohol, my therapist retains the right to stop the session.

CONFIDENTIALITY

The session content and all relevant materials to the client’s treatment will be held confidential unless the client requests in writing to have all or portions of such content released to a specifically named person/persons. Limitations of such client held privilege of confidentiality exist and are itemized below:

1. If a client threatens or attempts to commit suicide or otherwise conducts him/her self in a manner in which there is a substantial risk of incurring serious bodily harm.
2. If a client threatens grave bodily harm or death to another person.
3. If the therapist has a reasonable suspicion that a client or other named victim is the perpetrator, observer of, or actual victim of physical, emotional or sexual abuse of children under the age of 18 years.
4. Suspicions as stated above in the case of an elderly person who may be subjected to these abuses.
5. Suspected neglect of the parties named in items #3 and # 4.
6. If a court of law issues a legitimate subpoena for information stated on the subpoena.
7. If a client is in therapy or being treated by order of a court of law, or if information is obtained for the purpose of rendering an expert’s report to an attorney.

Occasionally, I understand that WWC may consult with other professionals in their areas of expertise in order to provide the best treatment for me. Information about me may be shared in this context without using your name.

If my WWC therapist sees me accidentally outside of the therapy or coaching office, I may wave or choose to ignore my therapist in public. I understand my right to privacy and confidentiality is of the utmost importance to me, and to WWC and WWC does not wish to jeopardize my privacy. I understand WWC does not find it appropriate to engage in any lengthy discussions in public or outside of the therapy or coaching office about private matters.

TELEHEALTH

I can expect to meet for my video telehealth session using the Simple Practice Telehealth App. I will download this app in advance of my first session, to be prepared. I will ensure me and my child or teen has the Simple Practice Telehealth app downloaded in advance of a video session to ensure all can join smoothly at the start time. I will be in a quiet place, with good wi-fi, present, and plan accordingly, so I am not in a car with people, for instance. There will be a link to my video session in my client portal and I will also be emailed a link for the telehealth video session ten minutes beforehand. I will arrive in the telehealth session five minutes in advance and I will see “waiting for the participant.” When the session starts, my therapist’s face will appear. I understand that my WWC therapist will call me on my cell phone if the video session is disconnected due to technological errors. Then, I understand the remaining time of the session will be conducted over phone, if technological video issues persist.

For teletherapy, WWC complies with HIPAA guidelines using Simple Practice HIPAA compliant video telehealth program. I am aware that I can opt out at any time from telehealth services and do face to face sessions. iPhone Face Time is not a confidential video platform for counseling sessions. However, WWC offers this to clients who elect to use it for ease. WWC and this client understand that FaceTime is not HIPAA compliant, but I can elect to use FaceTime for my telehealth session, knowing this. Phone sessions are also not HIPAA compliant. I am signing the agreement that WWC therapists and coaches are willing to do sessions over phone, but WWC cannot guarantee HIPAA compliance. By signing this I understand that FaceTime and phone audio only sessions are not HIPAA compliant, and I know I may jeopardize my confidentiality by using FaceTime or phone platforms.

INSURANCE

I am aware Wisdom Within Counseling does not bill insurance directly. We do not accept CT husky insurance. I understand Wisdom Within counseling does not call insurance companies. Also, I understand Wisdom Within Counseling requires payment in full for the first session in order to book and reserve it, and 48 hours before my future sessions, when the late policy goes into effect. It is my responsibility to ensure I have enough money in my account to avoid an overdraft fee. It is my responsibility to contact my insurance company to understand my out-of-network coverage benefits before beginning treatment.

HIGHER LEVEL OF CARE

I understand that my first session is an assessment. If my therapist determines that I am not appropriate for outpatient, weekly therapy, I will take their clinical recommendation into consideration to do an insensitive outpatient program. I understand that my therapist will not be able to see me anymore in outpatient therapy if I am recommended for a higher level of care.

EQUINE AND ANIMAL THERAPY

Wisdom Within Counseling offers a treatment modality called Equine Assisted Psychotherapy as well as animal therapy with other animals, which is an experiential form of psychotherapy where animals are involved in the sessions. Other animals may be involved including dogs, cats, and other animals. “Experiential” means that I will be involved in hands-on experiences with the animals and horses designed to reflect things going on in my life. The process is not always about interacting with the treatment team, although that will happen at times. It is about providing me the opportunity to experience, explore, problem-solve, discover, be creative, gain insight and experience practical applications of what I am learning at the moment. The process is about “doing” along with the “talking.” Wisdom Within Counseling is not responsible for any injuries whatsoever in animal therapy of any kind. There are some risks in being around animals due to their size, in some cases, and nature of being an animal. I understand that me and my child must listen to the therapeutic instructors. I release WWC of all responsibility. Wisdom Within Counseling is not liable for any injuries, diseases, or illnesses from any counseling format. I release Wisdom Within Counseling of all responsibility and liability, if myself or my child is physically injured during equine and animal therapy.

YOGA THERAPY

Yoga Therapy is an experiential therapy offered by Wisdom Within Counseling, LLC.I understand yoga is much more than physical exercise; it is a transformational practice that integrates body, mind, and spirit. Yoga therapy is specialized and is a way of encountering and releasing physical, mental, and emotional tensions to arrive at deeper levels of relaxation and awareness. I understand yoga therapy is optional. All exercise programs involve a risk of injury. By choosing to participate in yoga therapy, I voluntarily assume a certain risk of injury. I understand I am responsible for reducing my risk of injury. I understand I must listen to and follow instructions carefully. Breathe smoothly and continuously as you move and stretch. I will not hold my breath or strain to attain any position and know when to rest. I will work gently, respecting my body’s abilities and limitations. I will not perform postures or movements that are painful. Pregnant women must consult their health care provider before doing yoga therapy. It is my responsibility to consult my physician before embarking on any yoga or exercise program. Awareness is fundamental to the practice of yoga. It is my responsibility as to monitor each activity and determine whether it is appropriate for me. I understand that I am responsible for my own safety and well-being. Wisdom Within Counseling, LLC is responsible for providing yoga therapy, but WWC is not liable for ensuring my safety beyond providing instruction. By signing this form, I hereby release Wisdom Within Counseling, LLC from any and all liability for injuries from yoga.

HEALING TOUCH FOR CHILDREN, TEENS, AND ADULTS

I understand that yoga therapy can include healing touch, which is a gentle hands-on energy technique that is used for stress reduction and relaxation. I understand that yoga therapy can compliment any medical or psychological care I may be receiving. I also understand that the body has the ability to heal itself and to do so, complete relaxation is often beneficial. I acknowledge that long term imbalances in the body sometimes require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself. Healing touch in yoga therapy is healing energy and it is also a form of holistic complementary therapy for many of the body’s ailments. Healing touch is a choice you get to make by verbally saying, “yes,” or “no,” in sessions. Healing touch is a gentle, non-invasive, hands-on healing technique for balancing and re-connecting of the body, mind, emotions, and soul. Healing occurs on many levels. We are complex beings, much like a diamond that is multifaceted and multidimensional. Yoga therapy can help, but can’t guarantee success in healing my subtle body, the seven chakras, aura, neurology, and deeper cellular structures of the physical body. My commitment to the process will allow healing to occur. Foot rubs and heal rubs are common forms of healing touch at Wisdom Within Counseling that I may elect and choose to have and can be combined with talk counseling in child therapy, teen therapy, and adult therapy, couples, therapy, as well as family therapy.

COMMUNICATION OUTSIDE OF THERAPY

WWC offers texting to clients. If I choose to text, I understand my therapist will respond within 48 hours. Texts are for easy rescheduling and brief communication. By singing this form, I take responsibility that I will be respectful over text. If I am disrespectful to my therapist, or anyone on our WWC team, I understand I may be asked to leave and be no longer permitted to be a client. I understand I will be given a single warning if texts are deemed disrespectful.

TELETHERAPY, VIDEO/PHONE SESSIONS

WWC offers Teletherapy, which is therapy from a distance counseling. I consent to video and phone therapy. If I can’t make it to your session for any reason, from weather related cancellations to child care, video is an alternative to meeting in-person. If I am are cohabiting, please find a quiet space to talk. By signing this, I consent to video and phone, distance counseling sessions and know that I can opt out at any time. Video, phone, and texting therapy may not be covered by your insurance and varies. I consent to telecommunication, and agreed to find a quiet space to conduct the sessions where I can remain present and focused. I am aware that to avoid a late cancellation fee, I have the option to always have a telephone or video session instead, and can’t change the time of my session unless I pay a fee. If I become actively suicidal on a teletherapy call or video chat, I fully understand that my therapist will call the people listed in my release of information and my emergency contact, as well as the local police to do a safety check at my home.

CONSENT FOR TELEHEALTH CONSULTATION

1. I understand that my health care provider wishes me to engage in a telehealth consultation.
2. My health care provider explained to me how the video conferencing technology that will be used to affect such a consultation will not be the same as a direct client/health care provider visit due to the fact that I will not be in the same room as my provider.
3. I understand that a telehealth consultation has potential benefits including easier access to care and the convenience of meeting from a location of my choosing.
4. I understand there are potential risks to this technology, including interruptions, unauthorized access, and technical difficulties. I understand that my health care provider or I can discontinue the telehealth consult/visit if it is felt that the videoconferencing connections are not adequate for the situation.
5. I have had a direct conversation with my provider, during which I had the opportunity to ask questions in regard to this procedure. My questions have been answered and the risks, benefits and any practical alternatives have been discussed with me in a language in which I understand.

CONSENT TO USE THE TELEHEALTH BY SIMPLEPRACTICE SERVICE

Telehealth by SimplePractice is the technology service I will use to conduct telehealth videoconferencing appointments. It is simple to use and there are no passwords required to log in. By signing this document, I acknowledge:

1. Telehealth by SimplePractice is NOT an Emergency Service and in the event of an emergency, I will use a phone to call 911.
2. Though my provider and I may be in direct, virtual contact through the Telehealth Service, neither SimplePractice nor the Telehealth Service provides any medical or healthcare services or advice including, but not limited to, emergency or urgent medical services.
3. The Telehealth by SimplePractice Service facilitates videoconferencing and is not responsible for the delivery of any healthcare, medical advice or care.
4. I do not assume that my provider has access to any or all of the technical information in the Telehealth by SimplePractice Service – or that such information is current, accurate or up-to-date. I will not rely on my health care provider to have any of this information in the Telehealth by SimplePractice Service.
5. To maintain confidentiality, I will not share my telehealth appointment link with anyone unauthorized to attend the appointment.

By signing this form, I certify:

• That I have read or had this form read and/or had this form explained to me
• That I fully understand its contents including the risks and benefits of the procedure(s).
• That I have been given ample opportunity to ask questions and that any questions have been answered to my satisfaction.

WALK AND TALK SESSIONS, OUTSIDE

Walk and Talk Therapy is an option as part of my healing process. I understand that I may request that my session take place within the office at any point. By signing this form, I further agree to the following: I agree that I am responsible for setting the walking pace of the walk/talk session. I understand that this is not exercise or workout training, and that while movement may be a benefit to me physically, the focus is not about exercise. I agree to communicate with my therapist if I am uncomfortable physically or emotionally while participating in walk/talk therapy. I take full responsibility for my medical and physical well-being and will not hold Wisdom Within Counseling legally or financially responsible for any medical conditions and/or accidents that may arise out of walk/talk therapy. I agree to seek a doctor’s approval before beginning walk/talk therapy if appropriate. If I have any medical conditions that would be detrimental to walk talk therapy, I agree to disclose this and understand my therapist may not be able to offer this as an option. I understand that if my therapist and I come into contact with a person that I know, I have the right to disclose or not to disclose that I am in a therapy session. I understand that someone I don’t know may say, “Hello,” to my therapist on the walk. My therapist will say, “Hello,” briefly and continue our walk. I understand that my therapist will follow my lead should we come into contact with a person I know and my therapist will make every effort to preserve client confidentiality and privacy while conducting my walk/talk therapy session. I understand that if my therapist should come into contact with a person he/she knows, my therapist will not acknowledge me as a client or the walk/talk therapy session as counseling to preserve confidentiality. I agree that I have had all questions answered by my therapist. I understand and agree to the above regarding Walk/Talk Therapy as an option just as yoga, art, music, and animal therapies are options for my therapy.

COURT FEES

WWC therapists are not intended to go to court. They are here to support positive coping skills for lifelong success and confidence.

I agree not to subpoena my therapist at Wisdom Within Counseling. I acknowledge that court fees are non-negotiable and if this policy is disregarded, I must pay $4400 in full in advance regardless of whether I have been afforded a reduced fee for therapy services. Court fees are non negotiable and are not reimbursed by insurance. We require all our clients agree not to subpoena us to court as court involvement takes away from our time and energy dedicated to our specialized counseling services.

Wisdom Within Counseling maintains the right to bill the clients’ attorney’s or lawyer’s office to then bill the client if the client’s card has been declined or client has not paid. In order for a therapist or documents to be subpoenaed, payment must be received four weeks before subpoena date and time.

Informed Consent for Video and Audio Recording

Wisdom Within Counseling is a teaching practice and to better teach, guide, and support, therapists may record audio or video from my session to use in supervision with Katie Ziskind LMFT to listen to and review to improve therapy skills. I give my permission to record my counseling session(s) on video or audio file(s). The purpose of this recording is to help our therapists serve clients better and to review and evaluate the counseling techniques therapists at Wisdom Within Counseling use. No recording will be done without your prior knowledge and verbal consent. Viewers of the video file(s) may include licensed supervisors and peers in my group supervision class. All viewers of the video file(s), including myself, are bound by the ethical standards of the American Counseling Association and AAMFT. The video file(s) will be treated with confidentiality by being stored on a password protected computer and will be destroyed at the termination of the semester. By signing below, I am stating that I have read and understood the Informed Consent for Video Recording and that I am permitting Wisdom Within Counseling to record audio and video of my sessions.

LETTER FEES

Letters which are not limited to, but may include a letter of clinical recommendation to my child’s school principal, school psychologist, lawyer, or attorney. The $100 fee is due, and will be charged to the card on file, the day I request a letter. The fee is charged in advance on the letter. I ,may use a super bill with my diagnosis for many purposes. I understand letters take time, thought, and effort, which requires an extra fee. Your letter will be emailed to you or with a release of information on file, to whom you request, within 48 hours of your request.

CLINICAL RECOMMENDATIONS

If I decline all and any recommendations made by any clinical team member, Wisdom Within Counseling is not liable. If I do not follow clinical recommendations and on my own, choose to discontinue treatment, WWC is not liable. If my child or teen has been at risk of self-harm, suicidal ideation, or other negative behaviors, and a clinical team member recommends a therapeutic intervention or level of care, and I choose to decline, Wisdom Within Counseling, therapists, and clinical staff, are not liable for any increased suicidal thinking or self-harm. All recommendations by the clinical team are for my family’s best interest. WWC is thinking of my safety, my child or teen’s safety, and my whole family’s wellbeing, which is why WWC recommends what we do. If I want to discontinue treatment and end therapy, WWC recommends tapering down from 2x a week, to weekly, to 2x a month, to monthly. This recommendation as to ending therapy and treatment is especially important with people who are at high risk such as with alcoholism, self-harm, eating disorders, and people who are suicidal. As parents, it is important I uphold my child or teen to WWC clinical recommendations for their safety. In conclusion, if I don’t take our clinical recommendations with my child’s safety in mind, Wisdom Within Counseling is not at fault in any way if harm comes to my child or my child harms them self or anyone else. If my child harms me, I release WWC of all liability because I didn’t take the clinical recommendation from a master’s level therapist. I release all fault of WWC in the case I disregard clinical recommendations from any member of the team.

ALLERGIES AND ILLNESS

I consent to listing all my child’s and my allergies on my intake form and making their therapist aware. I am aware therapists may eat in their offices, and eat peanuts, nuts, dairy, and gluten and therapists may offer me or my child a small snack or food when hungry. I release WWC of all liability related to harm caused by, but is not limited to, temporary or permanent disability, sickness, accident, injury, foodborne illness, the common cold, poison ivy, poison oak, poisonous plants, tics, COVID-19, coronavirus, or an allergic reaction. Allergic reaction or any illness, disability, injury, or sickness shall not be the fault or responsibility of WWC.

COACHING INFORMATION

Coaching Sessions Are Not Considered Therapy, But All Wisdom Within Policies and Consent Agreements Apply

By scheduling a coaching session I agree that this is coaching and is not mental health therapy. Coaching is appropriate for problem-solving and advice on specific issues and not for treatment of mental health issues. Coaching is not a service that is reimbursed by insurance. Coaching is non-refundable and paid in advance. I understand that life coaching does not treat mental disorders as defined by the American Psychiatric Association. I understand that life coaching is not a substitute for counseling, psychotherapy; psychoanalysis, mental health counseling. As a coaching client, I understand and agree that I am fully responsible for my well-being during my coaching sessions, including my choices and decisions. I am aware that I can choose to discontinue coaching at any time. I recognize that coaching is not psychotherapy and that professional referrals to master’s level therapists will be given if needed. I understand that “life coaching” is a relationship I have with my coach that is designed to facilitate the creation/development of personal, professional, or business goals and to develop and carry out a strategy/plan for achieving those goals. I understand that life coaching is a comprehensive process that may involve all areas of my life, including work, finances, health, relationships, education and recreation. I acknowledge that deciding how to handle these issues and implement my choices is exclusive my responsibility. I promise that if I am currently in therapy or otherwise under the care of a mental professional, that I have consulted with this person regarding the advisability of working with a life coach and that this person is aware of my decision to proceed with the life coaching relationship. I understand that information will be held as confidential unless I state otherwise, in writing, except as required by law sign a ROI, or release of information. I understand that life coaching is not to be used in lieu of professional guidance of legal, medical, financial, business, spiritual or other matters. I understand that all decisions in these areas are exclusively mine and I acknowledge that my decisions and my actions regarding them are my responsibility.

CLINICAL INTERNSHIP PARTNERSHIPS

Treatment by Intern Informed Consent and Release Section

I understand Katie Ziskind, LMFT, RYT500, at Wisdom Within Counseling and Coaching supervises clinical master’s level interns each year. I understand that my child, my family, or myself will be receiving therapy services from a student intern who is under the supervision of Katie Ziskind, MA, LMFT, RYT500 at Wisdom Within Counseling and Coaching. Sessions conducted by an intern or unlicensed therapist are not reimbursable by insurance, and are private pay services only.

TREATMENT PLAN PARTICIPATION

I choose to actively participate in my treatment plan and by signing this, I will actively participate in my treatment planning process.

BY CLICKING ON THE CHECKBOX BELOW I AM AGREEING THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.

WISDOM WITHIN COUNSELING PRACTICE POLICIES

In the case of emergency, weather related, snow, or otherwise, I understand that my therapist or coach will contact me by phone or video for my scheduled in person session.

Teaching and Supervision: WWC is a teaching practice. To best train interns and recently hired therapists, WWC offers consultation and supervision. I understand I may have two therapists in my sessions for two supportive perspectives at times. I understand WWC has a mix of licensed therapists, clinical interns, and unlicensed associates working towards licensure and I may be placed with a therapist under direct supervision.

COUNSELING AND COACHING – APPOINTMENTS AND CANCELLATIONS

Forty-eight hour policies apply to all services, coaching, therapy, counseling, and all sessions. I understand I will need to contact my coach or therapist directly to reschedule by calling with more than 48 hours notice to avoid a late fee or penalty. I will need to leave a voicemail on my therapist’s voicemail with more than 48 hours notice to avoid a fee. I will need confirmation that my therapist received my message in order to officially cancel. WWC had to institute late cancellation fees because there have been cases where people have not cancelled at least 48 hours ahead. This fee is non-negotiable and I understand the late fee will be charged to my card on file if 48 hours notice is NOT RECEIVED. WWC requires cancellations AT LEAST 48 HOURS IN ADVANCE of my session start time. The late fee is the full session fee and is discussed on the intake call. I understand the fee is non negotiable regardless of if I bring a doctor’s note, because that time was held and reserved.

I understand I may allow another family member to use the appointment such as a spouse, child, or parent to avoid a firm, non-negotiable late fee.

Because our late policy is 48 hours, we require 48 hours note for cancellations to avoid the late fee. WWC charges all client payments 48 hours in advance of a session. Payments are due 48 hours before a session. If my payment method/card on file is declined or says “Insufficient funds,” this session will be considered a late cancel and the full late fee will apply. I will be financially responsible for the full late cancellation fee, when a form of payment is declined. The late fee is the therapist’s full fee. WWC requires the full late fee be paid before I may book a new session. This is because the session where the card was declined, was held, reserved, and scheduled for me prior and other clients were told they could not have that session time. I am expected to pay my late fee and add a new card on file in my client portal immediately.

REFUNDS AND RECHARGES

When I request a refund or a recharge, I expect to lose the credit card processing fee on the refund. The credit card processing fee will be automatically deducted in the refund amount after WWC processes it. The fee I will not be refunded is 4% of the fee initially charged and refunded and that does not go back to the original form of payment.

WWC does not respond to emails or calls on the weekend or holidays. Consider our office a medical practice. I understand that WWC recommends that I call 911 or 211 when I am in crisis or in an emergency outside my session. I understand my therapist will take 48 business hours to respond outside of a session.

PAYMENT REQUIRED FOR BOOKING AN INTAKE SESSION

WWC collects payment for the intake upfront prior to booking my intake appointment. WWC can not schedule an intake appointment until payment is received in order to hold and reserve that session time, like a plane ticket. Once payment is received, for the first session, over the phone, then an intake coordinator will book the intake session in the therapist calendar, and I will then receive an appointment confirmation reminder upon WWC booking the appointment. I understand that I need to receive confirmation that I have a scheduled appointment. I understand WWC is not a walk-in clinic and by appointment only.

COACHING AND COUNSELING SESSION RATES

Our private practice offers coaching and counseling and does not accept insurance directly. Coaching is not reimbursable by insurance at all. Counseling sessions master’s level interns and therapist who are not reimbursable will not be reimbursed by insurance and are private pay only. Counseling sessions with unlicensed therapists and therapists who are not reimbursable will not be reimbursed by insurance. My per-session rate will be explained during my first intake call. It varies based per therapist. Yearly, my session fees will be increased due to business standards. Wisdom Within Counseling will provide me with a letter and email with 60 days notice. At this time, my therapist will discuss options of concluding treatment, paying the full fee, and referring me to another WWC therapist.

WWC do NOT accept any insurance. WWC does not speak to insurance companies.

Wisdom Within Counseling rates are based off a 45 or 50 minutes for appointments. Sessions are not pro-rated for a shorter time. If I choose to leave early, or don’t arrive on time, the fee is for the full session is the same if I am late, or if I stay for the full time.

Initial & Following Sessions range between $350-$99 per 30-50 minutes

If I cancel or reschedules the intake once I am off the phone with an intake coordinator, I understand the full session fee is non refundable. I may avoid the fee by choosing a video or phone location instead of in person.

NON REFUNDABLE PAYMENT OF FIRST SESSION

On my free phone consult, in order to to schedule and hold my first counseling session, WWC requires a non-refundable payment. I am making a one-time commitment when I book my first counseling session. Once my first session is booked, the fee for my first counseling session that I’ve paid will not be refunded to me if I can’t make it, cancel it, or reschedule it. The intake fee (first session fee) is non-refundable and will not be refunded if I cancel or reschedule it, even when more than 48 hours notice is provided. I will need to pay for and schedule an entirely new intake.

LATE CANCELLATION POLICY

Once within the 48 hour late cancellation policy, the full fee is the cancellation fee for all appointments after the intake. The 48 hour late cancellation policy doesn’t apply to the intake.

I understand Wisdom Within Counseling requires 48 hours notice to cancel or reschedule sessions after my first appointment and my late cancellation fee is my full session fee. Sessions may be done by phone or video if I can’t make it in person to avoid the late fee.

A $50.00 service charge will be charged for any checks returned for any reason for special handling or HSA, debit, or credit cards with insufficient funds.

DECLINED CARDS

I understand that I am responsible for having an accurate and billable card on file. I may adda new card in my portal at anytime. I will be notified via text when my card is declined. When my card on file is declined, I understand I am responsible for the full session fee for my upcoming planned session as because my card was declined, this session I had planned is now considered a late cancellation. I am expected to add a new card and pay for my session fee in my client portal within 24 hours from my card being declined. Once paid, if my session time is still available, the intake team at WWC can try to reinstate it for me, but it may not be possible. The late cancellation fee that I paid becomes the session fee when paid within 24 hours from my card decline notification and when the intake team is able to reinstate my session. When I add a new card and pay my overdue invoice after 24 hours from my card being declined, the late fee does not go towards any future session of mine and I understand I will need to schedule a new session completely after paying the late fee for my prior session. I understand WWC asks I pay my invoice in my portal immediately after my card is declined: https://wisdomwithin.clientsecure.me

WWC asks I text 860-451-9364 with questions and once I have paid my invoice.

RESPECTFULNESS POLICY

I understand the WWC team will treat me in a way that is affirming, kind, inclusive, understanding, and respectful and I am expected to do the same. If I use threatening, disrespectful, rude, racist, or intimating language with the WWC team, I will be declined services and not refunded if my session is less than 48 hours away.

GOOD FAITH ESTIMATE

WWC provides a good faith estimate including the following service codes, but are not limited to 90791 for the first session, 90837, 90834, 90846, 90847. WWC DOES NOT GUARANTEE INSURANCE REIMBURSEMENT. WWC recommends weekly 45-55 minute appointments when a client is stable and two times per week when a client is needing more support such as a couple post affair recovery or a teenager who is self-injuring. Clients are recommended to attend counseling regularly for six months minimum. The address where these services can be provided can be in person at 8 West Main St, 3-15, Niantic, CT 06357 or virtually over video or phone. The expected cost per six month commitment can be calculated by multiplying the cost per session by the number of weeks per year and dividing by two.

Working with a therapist who is $225 per 45-55 minute session, attending weekly appointments, a client can expect to pay an average of $5,962 per six months. Working with a therapist who is $180 per 45-55 minute session, attending weekly appointments, a client can expect to pay an average of $4470 per six months. Working with a therapist who is $150 per 45-55 minute session, attending weekly appointments, a client can expect to pay an average of $3975 per six months. This good fait estimate includes all the services that are reasonably expected to be provided from admission through discharge as part of the scheduled counseling experience. There are no add on costs or hidden fees. This good faith estimate does not cover unanticipated items or services that are not reasonable expected and that could occur due to unforeseen events.

TELEPHONE ACCESSIBILITY

If I need to contact my coach or therapist between sessions, I will leave a message on their voice mail. WWC is an outpatient setting. If a true emergency situation arises, I will call 911 or 211 or any local emergency room. Phone/Texting/Emailing is not HIPAA protected. I understand that I may elect to use these for convenience. At anytime, you can go to the WWC website www.WisdomWithinCt.com where you can schedule a call to speak about questions, changing therapists or coaches, and grievances.

In addition to telehealth, the WWC team of coaches and counselors offer outdoor play therapy for children with high energy for anxiety management. Also, WWC offers walk and talk beachside therapy for adults with depression and anxiety. Of course, outdoor nature therapy and beach therapy in East Lyme, Ct for high energy children, depressed teenagers and stressed young adults is always available. We always offer in person and online counseling and are happy to help in any way. WWC offers texting, video, and phone sessions from home.

CHANGING AND TRANSFERRING THERAPISTS BERE

I have the freedom to request a therapist change at any time. WWC wants to make sure all clients have the best fit therapist possible. If I feel unsatisfied or want a change, I may text or call 860-451-9364 to ask the intake team for a therapist change and they will set that up for me. This may mean a change in their fee.

WHAT IS TEXTING THERAPY?

Texting therapy is s a 45-minute scheduled session in from start to finish, a client and their therapist will text back-and-forth, send important photos, and emoji’s. I will have an instant message conversation via text for positive coping skills and anxiety management. There is no video in this format.

WHAT IS PHONE THERAPY?

Phone therapy is easy from Bluetooth headphones or by holding the phone to my ear. I will talk for 45 minutes with m therapist. If I am in a relationship, and the other person is not in the same room as me, I understand that they can call in remotely. There is no video in this format.

WHAT ARE VIDEO THERAPY SESSIONS?

For video sessions, you get audio and real time video with your therapist, and your spouse or partner can use the secure video link to enter the video chat from any location as well. I understand I will get an email 10 minutes before the session with a secure link and can enter the video call that way. If I am late, this cuts into my scheduled session time.

DIAGNOSIS

Certain mental health diagnoses can prevent children, in adult years, from going into certain careers one day. In private pay counseling, WWC offers me therapy without having to give me a permanent mental health diagnosis. When using my out-of-network insurance, therapists are required to give the insurance company my diagnosis or my child’s mental health diagnosis, which is a permanent part of mine and their medical record.

SOCIAL MEDIA AND TELECOMMUNICATION

Due to the importance of your confidentiality and the importance of minimizing dual relationships, WWC therapists do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc). WWC believes that adding clients as friends or contacts on these sites can compromise my confidentiality and my respective privacy. It may also blur the boundaries of the therapeutic relationship. If I message my therapist on Facebook, I understand that they will not respond.

ELECTRONIC COMMUNICATION

WWC cannot ensure the confidentiality of any form of communication through electronic media, including text messages. While WWC may try to return messages in a timely manner, WWC cannot guarantee immediate response.

Services by electronic means, including but not limited to telephone communication, the Internet, fax machines, and e-mail is considered telemedicine by the State of California. Under the California Telemedicine Act of 1996, telemedicine is broadly defined as the use of information technology to deliver medical services and information from one location to another. If you and your therapist chose to use information technology for some or all of your treatment, you need to understand that: (1) You retain the option to withhold or withdraw consent at any time without affecting the right to future care or treatment or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled. (2) All existing confidentiality protections are equally applicable. (3) Your access to all medical information transmitted during a telemedicine consultation is guaranteed, and copies of this information are available for a reasonable fee. (4) Dissemination of any of your identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without your consent. (5) There are potential risks, consequences, and benefits of telemedicine. Potential benefits include, but are not limited to improved communication capabilities, providing convenient access to up-to-date information, consultations, support, reduced costs, improved quality, change in the conditions of practice, improved access to therapy, better continuity of care, and reduction of lost work time and travel costs.

Effective therapy is often facilitated when the therapist gathers within a session or a series of sessions, a multitude of observations, information, and experiences about the client. Therapists may make clinical assessments, diagnosis, and interventions based not only on direct verbal or auditory communications, written reports, and third person consultations, but also from direct visual and olfactory observations, information, and experiences. When using information technology in therapy services, potential risks include, but are not limited to the therapist’s inability to make visual and olfactory observations of clinically or therapeutically potentially relevant issues such as: my physical condition including deformities, apparent height and weight, body type, attractiveness relative to social and cultural norms or standards, gait and motor coordination, posture, work speed, any noteworthy mannerism or gestures, physical or medical conditions including bruises or injuries, basic grooming and hygiene including appropriateness of dress, eye contact (including any changes in the previously listed issues), sex, chronological and apparent age, ethnicity, facial and body language, and congruence of language and facial or bodily expression. Potential consequences thus include the therapist not being aware of what he or she would consider important information, that you may not recognize as significant to present verbally the therapist.

MINORS If I am a minor, my parents may be legally entitled to some information about my therapy. WWC will discuss this with me and my parents and what information is appropriate for them to receive and which issues are more appropriately kept confidential.

YOUNG ADULTS If I am over 18 years old, and my parents/guardians are paying for me to attend therapy, I can add them to my Intake Questionnaire and Authorization for Disclosure and sign giving permission for them to be involved in my therapy. WWC encourages parents to have a conversation with their young adult over 18 years of age to discuss how much parental involvement is desired and needed by all parties. For young adults, when parents are too involved, young adults may feel invaded or stop therapy all together. When parents are not involved, a young adult may also discontinue due to not feeling family support. WWC can not allow a parent/guardian to cancel or reschedule an 18 year old’s appointment unless the 18 year old has signed the Release of Information section in the Intake Questionnaire or an Authorization of Disclosure including their parent/guardian.

TERMINATION

Ending relationships can be difficult. Therefore, it is important to have a termination process in order to achieve some closure. Typically, weekly session are backed down to every other week. The appropriate length of the termination depends on the length and intensity of the treatment. I may terminate treatment after appropriate discussion with my therapist and a termination process. WWC may also determine that the psychotherapy is not being effectively used or if I am owing money and past due payments, and terminate therapy. WWC does not permit over due balances.

If I have an over due balance, I will not be able to schedule.

I will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. Also, WWC clinically recommends a parent session to discuss issues behind termination when a child is involved in treatment. If therapy is terminated for any reason or I request another therapist, WWC will provide me with a list of qualified psychotherapists to treat me which can be found at www.WisdomWithinCt.com/support. When working with children or teens, an abrupt termination, such as abruptly stopping therapy, for any reason due to finances or personal issues, damages a child/teen emotionally. A child/teen has developed a connection and trust with their therapist, so stopping treatment without a goodbye session, closure, and an ending ritual, is negatively impactful emotionally on your child/teen. Therefore, WWC expects clients provide one month’s notice of stopping treatment for coordination of goodbye sessions after trust has been established.

RECORDS REQUEST:

I have the right to request my records. In order to request your records, I will need to provide written documentation of the reason for the request. My records will be prepared within 60 days of receiving my letter per request. I also need to provide a release of information for whom I would like the record to go to. This is a nonrefundable, one time fee of $350. Expect this to be charged to the card on file to prepay for the time, effort, energy, and extra clinical hours it takes to compile a client file for the records request.

Just a friendly reminder, locations of all sessions are determined on your intake phone call. You may choose online Telehealth video counseling or in person at 8 W. Main St. suite 3-15 in Niantic, CT 06357. I am aware I can stop telehealth anytime and do in person sessions.

Should you fail to schedule an appointment for THREE consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, I must consider the professional relationship discontinued. At that time, I understand WWC is not responsible for any negative or high risk behaviors during therapy and after a discontonued relationship.

ALLERGIES

Wisdom Within Counseling is not held responsible for allergic reactions that occur during session, during outdoor therapies, or in WWC offices. Wisdom Within Counseling is NOT a nut free office. I understand WWC is not nut free and I release WWC of all allergic reactions, illness, or sensitives I may have or develop, or my loved ones may have or develop, due to my actions of consciously, voluntarily attending therapy in person.

FREE PHONE CONSULT

I understand my free phone consult is not a therapy session. I will speak with an intake coordinator who will hear about my concerns and get my first counseling session scheduled with a therapist and pair me based on their experience, expertise, and their specialities.

INFORMED CONSENT FOR IN-PERSON SERVICES DURING COVID-19 PUBLIC HEALTH CRISIS

Decision to Meet Face-to-Face

I understand I have choices to meet over video, phone, texting for face-to-face. I agree to meet in person for some, none or all future sessions. If there is a resurgence of the pandemic or if other health concerns arise, however, WWC may require that we meet via telehealth. I understand that, if WWC believes it is necessary, WWC may determine that we return to telehealth for everyone’s well-being.

If I decide at any time that I would feel safer staying with, or returning to, telehealth services, WWC will respect that decision, as long as it is feasible and clinically appropriate. Reimbursement for telehealth services, however, is also determined by the insurance companies and applicable law, so that my responsibility to explore.

Risks of Opting for In-Person Services

I understand that by coming to the office face-to-face, I am assuming the risk of exposure to the coronavirus, flu, (or other public health risk). This risk may increase if I travel by public transportation, cab, or ride sharing service.

Your Responsibility to Minimize Your Exposure To Illness

To obtain services in person, I agree to take certain precautions which will help keep everyone (you, me, and our families, [WWC staff] and other patients) safer from exposure, sickness and possible death. Common areas are thoroughly disinfected at the end of each day. Tissues and trash bins are easily accessed. Trash is disposed of on a frequent basis. If you do not adhere to these safeguards, it may result in our starting / returning to a telehealth arrangement. By signing, I indicate that I understand and agree to these actions: 1) I will only keep my in-person appointment if I am symptom free. I will take my temperature at home before coming to each appointment. If it is elevated (100 Fahrenheit or more), or if I have other symptoms of the coronavirus, I agree to cancel the appointment and pay a late fee, or proceed using telehealth video for the scheduled appointment.  I will try not to touch my face or eyes with my hands. If I do, you will wash my hands. If I am bringing my child, I will make sure that my child follows all of these protocols. If I have a job that exposes myself to other people who are infected, I will immediately let WWC know. If a member of my home tests positive for the infection, I will immediately let WWC know, and will do treatment via telehealth for two to four weeks. WWC may change the above precautions if additional local, state or federal orders or guidelines are published.

If You or I Are Sick

I understand that WWC is committed to keeping therapists, me, and all of our families safe from the spread of this virus. If I show up for an appointment and WWC believes that I have a fever or other symptoms, or believe I have been exposed, WWC will have to require me to leave the office. I can follow up with services by telehealth as appropriate.

ABOUT THE CREATIVE THERAPIES

I can pick from traditional talking, creative art, yoga, music, outdoor walking, and video therapies, or a combination. When talking is difficult, I can choose creative art and music, which are a language beyond words including paints, glitter gel pens, watercolors, and clay. Also, I can go for an outdoor walk-and-talk session by the beach in the sun, helping to move depression and build lifelong coping skills. I can do mind-body therapies like yoga and mindfulness meditations to help you feel stronger, clear your head, and build a self-care toolbox. I can always come in and sit on one of our comfy couches and sit, unload stress, and simply talk too.

ADULT INTAKE – I understand an adult intake is a information gathering session between me and my therapist. If I feel like my intake therapist would be a good fit, that’s great, or I can ask to get scheduled with another one of the WWC therapists. I understand WWC highly suggests weekly appointments and parenting appointments. .

MINOR INTAKE – I understand a child intake is a parent-only session and the therapist will ask questions about my child’s life, which lays a foundation for emotional goals, without your child in the first session. If my child has two homes, I may schedule two separate parent-only intakes.

COUPLES INTAKE – I understand that the first relationship or marriage therapy session is an information gathering session about my couple unit and goals. I can talk about and discuss goals for intimacy, overcoming betrayal, closeness, trust, and meaningful connection.

The paperwork being completed is required before all clients come in. WWC has a policy that paperwork must be back before booking an an intake appointment.

BY CLICKING ON THE CHECKBOX BELOW I AM AGREEING THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.

NOTICE OF PRIVACY PRACTICES FOR WISDOM WITHIN COUNSELING

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. WISDOM WITHIN COUNSELING’S PLEDGE REGARDING HEALTH INFORMATION: WWC understands that health information about me and my health care is personal. WWC is committed to protecting health information about you. WWC creates a record of the care and services I receive from WWC. WWC needs this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of my care generated by this mental health care practice. This notice will tell WWC about the ways in which they may use and disclose health information about me. WWC also describe your rights to the health information kept about me, and describe certain obligations WWC has regarding the use and disclosure of my health information. WWC is required by law to:

• Make sure that protected health information (“PHI”) that identifies me is kept private.

• Give me this notice of WWC’s legal duties and privacy practices with respect to health information.

• Follow the terms of the notice that is currently in effect.

• WWC can change the terms of this Notice, and such changes will apply to all information WWC has about you. The new Notice will be available upon request, in my office, and on my website.

II. HOW WWC MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT ME: The following categories describe different ways that WWC use and disclose health information. For each category of uses or disclosures WWC will explain what WWC means. Not every use or disclosure in a category will be listed. However, all of the ways WWC is permitted to use and disclose information will fall within one of the categories.

For Treatment Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. WWC may also disclose my protected health information for the treatment activities of any health care provider. This too can be done without my written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, WWC would be permitted to use and disclose my person health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of my mental health condition.

Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.

Lawsuits and Disputes: If I am involved in a lawsuit, WWC may disclose health information in response to a court or administrative order. WWC may also disclose health information about my child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell me about the request or to obtain an order protecting the information requested.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

1. Coaching and psychotherapy Notes. WWC do keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires my Authorization For Disclosure unless the use or disclosure is:

a. For WWC’s use in treating me.

b. For WWC’s use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.

c. For WWC’s use in defending myself in legal proceedings instituted by me.

d. For use by the Secretary of Health and Human Services to investigate WWC’s compliance with HIPAA.

e. Required by law and the use or disclosure is limited to the requirements of such law.

f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.

g. Required by a coroner who is performing duties authorized by law.

h. Required to help avert a serious threat to the health and safety of others.

2. Marketing Purposes. As a psychotherapist group, WWC will not use or disclose your PHI for marketing purposes.
3. Sale of PHI. As a psychotherapist group, WWC will not sell your PHI in the regular course of business.

IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION. Subject to certain limitations in the law, WWC can use and disclose your PHI without your Authorization for the following reasons:

1. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
2. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
3. For health oversight activities, including audits and investigations.
4. For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain an Authorization from me before doing so.
5. For law enforcement purposes, including reporting crimes occurring on WWC premises.
6. To coroners or medical examiners, when such individuals are performing duties authorized by law.
7. For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.
8. Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
9. For workers’ compensation purposes. Although WWC’s preference is to obtain an Authorization from me, WWC may provide your PHI in order to comply with workers’ compensation laws.
10. Appointment reminders and health related benefits or services. WWC may use and disclose your PHI to contact me to remind me that I have an appointment with WWC. WWC may also use and disclose your PHI to tell me about treatment alternatives, or other health care services or benefits that are offered.

V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.

1. Disclosures to family, friends, or others. WWC may provide my PHI to a family member, friend, or other person that I indicate is involved in my care or the payment for my health care, unless I object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

1. The Right to Request Limits on Uses and Disclosures of my PHI. I have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. WWC is not required to agree to your request, and may say “no” if WWC believes it would affect my health care.
2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. I have the right to request restrictions on disclosures of my PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that I have paid for out-of-pocket in full.
3. The Right to Choose How WWC Sends PHI to Me. I have the right to ask WWC to contact me in a specific way (for example, home or office phone) or to send mail to a different address, and WWC will agree to all reasonable requests.
4. The Right to See and Get Copies of My PHI. Other than “psychotherapy notes,” I have the right to get an electronic or paper copy of my medical record and other information that WWC has about me. WWC will provide me with a copy of my record, or a summary of it, if I agree to receive a summary, within 30 days of receiving your written request, and WWC will charge $350 per request.
5. The Right to Get a List of the Disclosures WWC Has Made. I have the right to request a list of instances in which WWC has disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which I provided WWC with an Authorization. WWC will respond to my request for an accounting of disclosures within 60 days of receiving my request. The list WWC will give me will include disclosures made in the last six years unless I request a shorter time. WWC will provide the list to me at no charge, but if I make more than one request in the same year, WWC will charge you a reasonable cost based fee for each additional request of $250 per request.
6. The Right to Correct or Update Your PHI. If I believe that there is a mistake in my PHI, or that a piece of important information is missing from my PHI, I have the right to request that WWC correct the existing information or add the missing information. WWC may say “no” to your request, but WWC will tell you why in writing within 60 days of receiving your request.
7. The Right to Get a Paper or Electronic Copy of this Notice. I have the right get a paper copy of this Notice, and I have the right to get a copy of this notice by e-mail. And, even if I have agreed to receive this Notice via e-mail, I also have the right to request a paper copy of it.
8. RECORDS REQUEST: I have the right to request my records. In order to request my records, I will need to provide written documentation of the reason for the request. My records will be prepared within 60 days of receiving my letter per request. I also need to provide a release of information for who I would like the record to go to. This is a nonrefundable, one time fee of $350. This will be charged to the card on file to prepay for the time, effort, and extra clinical hours it takes to compile a client file for my records request.

EFFECTIVE DATE OF THIS NOTICE

This notice went into effect on September 20, 2013

Acknowledgement of Receipt of Privacy Notice

Coaching is not HIPAA protected, but the WWC team complies with many of the HIPAA guidelines for coaching clients. Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), I have certain rights regarding the use and disclosure of my protected health information. By checking the box below, I acknowledge that I have reviewed and received this copy of HIPAA Notice of Privacy Practices.

Wisdom Within Counseling requires all clients to electronically sign these policies within our electronic health record system before scheduling a first appointment.