CLINICAL SERVICES AND PRACTICE POLICIES AGREEMENT

Effective Date: [Date]

 

This Clinical Services and Practice Policies Agreement (“Agreement”) outlines how Get Healthy Directory and its affiliated licensed clinicians (collectively, the “Clinic,” “we,” or “our”) provide mental health services. The

By enrolling for services or participating in treatment, you enter a clinical relationship with the Clinic and its licensed providers. This Agreement, along with your treatment plan and communications with your clinician, sets the terms of your care. By continuing to use the Services, you confirm that you have read, understood, and agreed to this Agreement. We may update these policies from time to time, and you are responsible for reviewing them.

 

1. SERVICES AND USE OF TECHNOLOGY

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As a Clinic patient, you may have access to secure online tools, such as web or mobile applications. These tools let you schedule appointments, communicate with your clinician, review billing information, and access educational or care-related resources. They are designed to support, not replace, clinical judgment or emergency services.

You may use the Services if you are at least 18 years old or have the consent and legal authority of a parent or guardian, and are legally able to enter into binding agreements. By continuing to use the platform after policy changes, you accept the updated terms, as permitted by law.

Some digital features, including automated or AI-supported tools, may offer educational or supportive content. These tools do not provide diagnoses or emergency services. If safety concerns arise, crisis resources may be provided, and clinicians may be notified when appropriate. These features are meant to supplement, not replace, professional care.

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 2. TELEHEALTH INFORMED CONSENT 

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Clinical services may be delivered via telehealth, including video sessions, voice calls, and secure messaging. Telehealth provides access to care without travel, but it may not be suitable for all conditions. Some symptoms may require in-person evaluation or emergency care.

All confidentiality, privacy, and medical record protections that apply to in-person care also apply to telehealth under federal and state law. You have the right to access your records, request corrections, and receive care without discrimination.

You may withdraw your consent to telehealth at any time. Declining telehealth will not affect your right to seek other healthcare services, but it may limit your ability to receive care from this Clinic.

IMPORTANT: Our staff and digital tools do not provide emergency services. If you or your child is in danger, experiencing a medical emergency, or at risk of self-harm or harm to others, contact local emergency services or go to the nearest emergency room immediately.

 

 3. CONSENT FOR SERVICES TO MINORS

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If you consent to treatment for a minor, you confirm that you have the legal authority to authorize healthcare services for the child. If custody is shared or restricted, you are responsible for obtaining consent from all required parties and providing documentation upon request.

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If guardianship or custody status changes, you must promptly notify the Clinic. Failure to provide accurate legal authority may lead to suspension or termination of services.

In most cases, if a parent or legal guardian with appropriate authority withdraws consent, treatment will be discontinued unless an emergency or legal exception applies. Clinicians may recommend transition or closing sessions to support continuity of care when appropriate

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 4. ROLE OF PARENTS, GUARDIANS, AND COLLATERAL PARTICIPANTS

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When a child receives therapy, parents or guardians may join sessions or share information to support treatment. In this role, they are considered “collateral participants,” not patients, and no separate medical record or diagnosis is created for them.

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Information provided by collateral participants may be included in the child’s medical record. Individuals with legal access to the child’s record may also access this information, as required by law. Confidentiality protections apply mainly to the patient, not to collateral participants.

Clinicians treating minors balance parental involvement with the child’s right to privacy, especially for adolescents. The sharing of information with parents is guided by professional ethics and state law, and clinicians may review these boundaries during treatment.

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Participation in therapy may involve emotional challenges, family conflict, or stress. While involvement can improve understanding and relationships, specific outcomes are not guaranteed. Clinicians may ask parents or caregivers to consider their own behaviors and family dynamics when relevant to treatment.

 

 5. PAYMENT AND BILLING

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Payment is due after each appointment unless insurance or legal requirements specify otherwise. If you use insurance, you are responsible for copayments, coinsurance, deductibles, and any non-covered services as determined by your plan.

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By providing payment information, you authorize the Clinic or its billing partners to charge your payment method for amounts you owe and to store your payment details for future transactions. Third-party payors, such as insurance companies, pay providers directly. You remain responsible for any outstanding balances unless prohibited by law.

Please direct billing questions to the Clinic’s contact channels.

 

 6. REFUND POLICY

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Refunds may be issued for verified overpayments, duplicate payments, billing errors, or charges for services not rendered. Refund eligibility is determined by the billing department based on available records and applicable payor rules.

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Submit refund requests within thirty (30) days of the charge or discovery of the error. Approved refunds are typically issued to the original payment method within a reasonable timeframe. The Clinic may deny refund requests that do not meet eligibility criteria or are submitted after the deadline, unless required by law.

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Services provided as scheduled and in accordance with the treatment plan are generally not refundable. Address billing disputes unrelated to payment errors through the Clinic’s complaint or review procedures.

 

 7. APPOINTMENTS, CANCELLATIONS, AND ATTENDANCE

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Cancel or reschedule appointments at least twenty-four (24) hours in advance unless your clinician states otherwise. Late cancellations or missed appointments may result in charges, as permitted by law and insurance rules.

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Arriving more than fifteen (15) minutes late may be considered a missed appointment, depending on provider availability. Repeated missed appointments or extended non-response may result in termination of services and discharge from care, with referrals provided when feasible.

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Clinicians may grant exceptions for emergencies or extraordinary circumstances at their discretion

 

 8. PRIVACY AND CONFIDENTIALITY

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The Clinic complies with federal and state healthcare privacy laws, including HIPAA, and maintains safeguards to protect your health information. Details on how your information is used, disclosed, and protected, as well as your rights, are provided in our Website Privacy Policy, available upon request and on our website. information may be shared for treatment, payment, and healthcare operations, with other healthcare providers, health plans, and authorized caregivers, and in emergencies or where legally required.

We use security measures such as encryption and secure systems, but no electronic system is completely secure. We cannot guarantee absolute protection of information transmitted over the internet.

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 9. COMMUNICATIONS

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We may contact you by phone, email, or text message regarding appointments, treatment coordination, billing, and administrative matters if you provide your contact information. Electronic communications may not always be secure.

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By providing your contact details, you consent to receive service-related communications. You may opt out of non-essential messages, but appointment and care-related messages may still be sent as needed for treatment coordination.

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Standard messaging rates may apply, depending on your mobile service provider.

 

 10. COMPLAINTS AND GRIEVANCES

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You have the right to express concerns or file complaints about services received. Submit complaints through our Contact Us page or other methods provided by the Clinic. Regulatory complaint information is available upon request or as required by state law.

Filing a complaint will not affect your ability to receive care.

 

 11. CONSENT AND ACKNOWLEDGMENT

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If you have questions about these policies or your treatment, please discuss them with your clinician or contact the Clinic directly. Open communication is essential for effective treatment.

By accepting this Agreement, you confirm that you have read, understand, and agree to these policies. If you are consenting on behalf of another person, you certify that you have legal authority to do so and accept responsibility for compliance.