Privacy Policy for In-Person & Remote Therapy Sessions

Welcome. This document explains the services you will receive, how your privacy is protected under HIPAA, and what to expect during our in-person and remote therapy sessions. Please read this carefully before signing. 

1. Our Professional Relationship

You will be working with an independent, licensed mental health professional. They are solely responsible for your clinical care and decision-making. You will receive your professional’s name, license type, and license number before your first session. 

2. Mental Health Services

Your care begins with a clinical evaluation of your mental health history and current symptoms. 

• What to Expect: Some questions may be sensitive or bring up strong emotions. This is a normal part of the process.
• Recommendations: After the evaluation, your professional will share their diagnostic impressions and may suggest a treatment plan (e.g., mindfulness or, if clinically necessary, a support animal).
• Discretion: All clinical decisions are made at the professional’s discretion; specific outcomes cannot be guaranteed. 

3. Teletherapy: Risks and Best Practices

Teletherapy is the delivery of mental health services via secure video or audio. While convenient, it has unique risks: 

• Privacy Risks: Using public Wi-Fi or being in a shared space could allow others to overhear your session.
• Technical Issues: Telephonic, internet, or software failures can disrupt sessions.
• Clinical Limitations: Remote therapy sessions make it harder for your professional to see certain nonverbal cues (e.g., body language).
• Crisis Delay: In a remote setting, response to an immediate crisis may be delayed. 

To protect yourself, please: 

• Use a private, quiet room and a secure, password-protected internet connection.
• Avoid using work-owned devices or public computers. Turn off “auto-remember” for your login credentials. 

4. Fees and Billing

• Transparency: All fees for evaluations and follow-ups will be disclosed before you start.
• Ongoing Care: If you continue therapy, you will be billed at the professional’s standard hourly rate. This rate also applies to time spent on reports, records requests, or legal matters.
• Nonpayment: If fees go unpaid, lawful collection methods may be used, which require a limited disclosure of your information. 

5. Your Right to a “Good Faith Estimate”

Under the No Surprises Act, you have the right to receive a “Good Faith Estimate (GFE)” explaining how much your care will cost if you are uninsured or self-paying.

Your total annual cost is estimated by multiplying the hourly rate by the number of sessions you attend.

If your actual bills are $400 or more above your GFE, you can dispute the bill.

For more information, visit the CMS No Surprises website or call 1 (800) 985-3059.

6. Privacy (HIPAA)

Your Protected Health Information (PHI) is kept confidential and shared only as allowed by law or authorized by you. You may revoke your consent to share PHI at any time in writing, though this will not apply to information already shared. 

7. Communication and Emergencies

• Nonurgent: Professionals are often in sessions and may not answer immediately. They aim to return calls within one business day.
• Urgent/Life-Threatening: If you are in a life-threatening emergency, call 911 or go to the nearest emergency room immediately. We are not an emergency service. 

8. Minors

These services are intended for adults. If the client is under 18, a parent or legal guardian must provide consent. Parents may have a legal right to examine their child’s treatment records depending on state law. 

9. State-Required Disclosures

Your professional’s specific credentials, address, and license information will be provided via a separate notice. By law, we must also disclose the following: 

• Ethics: Your professional must follow the professional code of ethics for their specific license and state jurisdiction.
• Sexual Intimacy: Ethical standards and state laws strictly prohibit sexual intimacy between a professional and a client.
• Confidentiality: Your in-person and remote therapy sessions are confidential except in specific legal or safety situations (detailed below). 

10. Clinical Records and Notes

Your professional maintains a clinical record (diagnostic impressions, progress notes, and billing). 

• Access: You may request to see or copy your clinical record in writing. Your professional may suggest reviewing these with you to ensure clarity.
• Psychotherapy Notes: Your professional may keep separate “personal notes.” These are highly protected and are not released without your written consent, unless required by law. 

11. How Your Information Is Used (HIPAA)

We generally only share your Protected Health Information (PHI) with your written permission. However, there are exceptions where we may share data without a separate release: 

• Coordination of Care: Sharing information with other healthcare providers involved in your treatment.
• Operations and Support: We use HIPAA-compliant vendors (Business Associates) for administrative tasks like billing, secure messaging, and scheduling.
• Professional Consultation: Your professional may consult with other experts to improve your care; identifying details are kept to a minimum. 

12. Exceptions to Confidentiality

We may be required to disclose your PHI without your consent in the following scenarios: 

• Mandatory Reporting: Suspected abuse or neglect of a child, elder, or vulnerable adult.
• Safety Threats: If you are a danger to yourself or others, we may notify law enforcement or emergency services.
• Legal Mandates: Compliance with court orders, subpoenas, or warrants.
• Professional Defense: If a legal or ethical complaint is filed against the professional.
• Workers’ Comp: As required for claims related to workplace injuries. 

4. Your RightsregardingYour PHI 

You have specific rights under federal law (HIPAA): 

• Right to Access: You can request copies of your health records.
• Right to Amend: You can request a correction to your record if it is incomplete or incorrect.
• Right to Restrict: You can request limits on how we share your info (though we are not always required to agree).
• Right to Confidential Communication: You can ask us to contact you at a specific phone number or mailing address.
• Right to an Accounting: You can request a list of certain disclosures we have made of your PHI.
• Right to File a Complaint: If you believe your privacy has been violated, you may contact the U.S. Department of Health and Human Services (1-800-368-1019) or us. You will not be penalized for filing a complaint.

By typing your name below and clicking “I AGREE,” you confirm that you have read and understood this Informed Consent and Privacy Notice. You agree to its terms, including the risks of teletherapy and the privacy practices outlined above. 

Refund Policy

Refunds may only be issued under the following limited circumstances. Refunds may be issued if the client does not meet clinical criteria for an ESA or PSA. Refunds may also be issued in cases of duplicate payment, accidental double charge, payment processing error, or when the service has not been initiated, meaning no intake has been completed and no assessment has been performed.

Refunds may only be issued under the following limited circumstances

Refunds may be issued if the client does not meet clinical criteria for an ESA or PSA, if a duplicate payment or accidental double charge occurs, if a payment processing error occurs, or if the service has not been initiated (no intake completed and no assessment performed).

Refunds are not issued for the following situations

Refunds are not issued for housing provider denial, housing provider misunderstanding of FHA requirements, dissatisfaction with the clinical outcome, a client’s decision not to proceed after the assessment, situations outside the clinician’s control, landlord refusal, delay, or non‑response, or any decision made by a third party.

Clinical Consultation Policy 

 

Clinical consultations include professional time, diagnostic evaluation, and clinical judgment. Because these services are delivered immediately through intake review and assessment:

Consultation fees are non‑refundable once the evaluation has begun.

A consultation does not guarantee issuance of an ESA or PSA letter. Letters are issued only when clinically appropriate and medically necessary.

ESA and PSA Documentation Policy 

 

Care Haven Pets LLC provides documentation based on clinical necessity under the Fair Housing Act (FHA). Housing providers make independent decisions and may be exempt under FHA guidelines.

Clinical determinations do not guarantee housing approval.

If a housing provider refuses an ESA/PSA request and is not exempt, Care Haven Pets LLC will provide support, including:

• Supplemental clarification letters

• Communication with the housing provider (if appropriate)

• Guidance on FHA rights

• Referral to HUD’s complaint process

• Referral to local Fair Housing organizations

This support does not include refunds, as clinical services have already been delivered.

FHA Compliance Disclaimer 

 

Under the Fair Housing Act (FHA), housing providers must evaluate ESA/PSA accommodation requests fairly unless exempt (e.g., owner‑occupied buildings with four or fewer units).

Care Haven Pets LLC’s role is to:

• Conduct a clinical assessment

• Determine necessity

• Provide documentation

Care Haven Pets LLC is not responsible for:

• Housing provider decisions

• Housing provider policies

• Housing provider misunderstandings of FHA

• Housing provider refusal

• Housing provider delays

• Housing provider discrimination

• Any third‑party outcome

Clients understand that FHA enforcement is handled through HUD, Fair Housing organizations, or legal channels — not through the clinician.

Chargeback Prevention & Dispute Policy 

 

Because clinical services are delivered immediately through intake review and assessment, chargebacks filed after service delivery are considered fraudulent disputes.

Care Haven Pets LLC will provide:

• Proof of service

• Intake documentation

• Assessment records

• Communication logs

• Signed agreements

• Completed clinical determination

Clients agree not to file chargebacks for:

• Housing provider denial

• Outcome dissatisfaction

• Misunderstanding of FHA

• Delays caused by third parties

All disputes must be handled directly with Care Haven Pets LLC.

 

PSA Training Cancellation Policy 

 

PSA training registrations are final and non‑refundable. Training materials and resources are allocated immediately upon registration, and fixed costs are incurred at the time of purchase.

Cancellations, “no‑shows,” or failure to complete training do not qualify for refunds.