Policies & Client Rights

• Services are provided by a Licensed Professional Clinical Counselor (LPCC), licensed through the Ohio Counselor, Social Worker, and Marriage and Family Therapist Board.
• Services may include mental health assessments, individual therapy, treatment planning, psychoeducation, and other clinically appropriate interventions within my professional scope of practice.
• Clinical diagnostic assessments may include screening for ADHD, Autism, and other mental health conditions. These assessments do not necessarily constitute formal psychological or neuropsychological testing.
• You are welcome to ask questions about my qualifications, treatment approaches, and whether a particular service is appropriate for your needs.

• Therapy is a collaborative process focused on understanding your experiences, identifying challenges, developing coping strategies, and supporting meaningful change.
• Potential benefits may include increased self-awareness, improved emotional regulation, stronger relationships, and improved overall well-being.
• Therapy may involve discussing difficult experiences, exploring uncomfortable emotions, or making changes that initially feel challenging.
• Although therapy can be beneficial, specific outcomes cannot be guaranteed.
• Your participation, feedback, and preferences are important. You are encouraged to discuss what is or is not working for you.
• You may ask questions, decline particular interventions, discuss alternative treatment options, request referrals, or discontinue services.

Clients have the right to:

• Receive respectful, professional, and nondiscriminatory care.
• Participate in treatment planning and decision-making.
• Ask questions about treatment, qualifications, fees, and confidentiality.
• Discuss treatment alternatives and request referrals.
• Decline particular interventions or withdraw consent, subject to applicable legal requirements.
• Raise concerns about services without fear of retaliation.
• Receive information about their privacy rights and applicable complaint procedures.

Clients are encouraged to:

• Participate actively in treatment to the extent they are able.
• Communicate scheduling changes as early as possible.
• Provide accurate and relevant information when reasonably possible.
• Discuss concerns that may affect treatment.
• Communicate when accommodations or additional support may be helpful.

• Information shared during therapy is generally confidential and protected under applicable state and federal laws.
• Confidentiality is not absolute. Certain circumstances may require or permit disclosure of information.
• These circumstances may include suspected abuse or neglect that must be reported, certain serious safety concerns involving yourself or others, applicable legal requirements, and permitted treatment, payment, or healthcare operations.
• A request for information, including a legal request, does not necessarily authorize unrestricted disclosure of your records.
• Whenever possible and appropriate, I will discuss necessary disclosures with you before information is shared.
• Additional details regarding confidentiality, permitted disclosures, and your rights are provided in the Notice of Privacy Practices.

• To provide thoughtful, ethical, and effective care, I may consult with other qualified mental health professionals regarding clinical questions, treatment approaches, or ethical considerations.
• Identifying information will be limited whenever possible.
• Any information shared during consultation will be handled in accordance with applicable confidentiality laws and professional ethical standards.
• Consultation does not replace my responsibility for your treatment or clinical decision-making.

• Standard therapy appointments are approximately 50 minutes unless otherwise arranged.
• Appointment frequency and duration are determined collaboratively based on clinical needs, treatment goals, availability, and applicable insurance requirements.
• Your scheduled appointment time is reserved specifically for you.

• Please provide at least 48 hours' notice when canceling or rescheduling an appointment.
• Appointments canceled or rescheduled with less than 48 hours' notice may be subject to a $50 late cancellation fee.
• If you reschedule and attend your appointment within the same calendar week (Monday through Sunday), the late cancellation fee will generally be waived, subject to appointment availability.
• Repeated last-minute cancellations or rescheduling can interfere with consistent care and limit appointment availability for other clients.
• If frequent last-minute changes become a pattern, we will discuss potential barriers to attendance and explore possible solutions or accommodations together.
• If the pattern continues after this discussion, future late cancellations may be subject to the $50 fee, even if a replacement appointment is attended within the same week.
• Exceptions may still be considered for emergencies, unexpected illness, or other significant circumstances.

• I understand that life happens! Appointments may occasionally be forgotten, schedules may become complicated, or unexpected situations may arise.
• Each client is eligible for one courtesy waiver of an otherwise applicable late cancellation or no-show fee during their course of treatment.
• When the courtesy waiver is used, you will be notified and reminded of the cancellation policy.
• Exceptions granted for emergencies, unexpected illness, or other significant circumstances do not automatically count toward your courtesy waiver.
• Future missed appointments or late cancellations may be subject to applicable fees.

• If you have not joined your scheduled appointment, I will remain available for up to 15 minutes after the scheduled start time.
• During this time, I will attempt to contact you using the telephone number provided in your client information.
• If you have not joined or made other arrangements within 15 minutes, I will end the appointment and document it as a no-show.
• A $50 no-show fee may apply, subject to the courtesy waiver, exceptions, rescheduling provisions, and applicable insurance restrictions.
• If you arrive within the 15-minute window, we may proceed with the remaining appointment time when clinically appropriate.
• Sessions will generally end at their originally scheduled time, even when you arrive late.
• Billing will reflect the services actually provided and applicable insurance requirements.

• I understand that emergencies, unexpected illness, caregiving responsibilities, and other unforeseen circumstances may make it difficult or impossible to attend an appointment.
• Exceptions to late cancellation and no-show fees may be considered individually at my discretion.
• Consideration will be given to the circumstances surrounding the missed appointment, clinical needs, and relevant accessibility accommodations.
• Exceptions granted for these circumstances do not automatically use your one-time courtesy waiver.
• My goal is to maintain a fair and consistent scheduling policy while recognizing that unexpected situations arise.

• The cost of services, applicable insurance arrangements, copayments, coinsurance, deductibles, and other financial responsibilities will be discussed as part of informed consent.
• Self-pay therapy sessions are $100 for approximately 50 minutes unless another rate has been agreed upon in writing.
• Insurance coverage and client financial responsibilities depend on individual benefits and applicable provider agreements.
• Clients are responsible for applicable charges consistent with their financial agreements, insurance coverage, and relevant laws.
• Late cancellation and no-show fees are separate from charges for completed therapy services and are not submitted to insurance as therapy sessions.
• These fees apply only when permitted by applicable law and insurance agreements.
• Ohio Medicaid clients will not be charged missed-appointment fees.
• If you have questions about charges or financial circumstances affecting treatment, please discuss them with me so we can explore available options.

• If you need to contact me between appointments, please use the approved communication methods provided by the practice.
• I will make reasonable efforts to respond to non-urgent messages within approximately one business day.
• Response times may vary due to clinical scheduling, weekends, holidays, or other circumstances.
• Between-session communication is generally intended for scheduling, administrative needs, and brief treatment-related coordination rather than ongoing therapy.
• Messages and voicemail are not continuously monitored.

• Email and text messaging may present privacy and security risks, particularly when using methods not specifically designed for healthcare communication.
• Electronic communication may be used for scheduling and limited administrative purposes when appropriate.
• Please avoid sending detailed clinical information or sensitive therapeutic content through ordinary email or text messaging unless an appropriate secure communication method has been established.
• Reasonable safeguards will be used to protect electronic communication, but complete security cannot be guaranteed.
• Therapeutically relevant communications may be documented in your clinical record.

• Connected Roots Counseling does not provide emergency services, 24-hour crisis monitoring, or immediate-response care.
• If you are experiencing an immediate emergency or are in imminent danger, call 911 or go to the nearest emergency department.
• For suicide-related or other mental health crisis support in the United States, call or text 988 to reach the Suicide & Crisis Lifeline.
• Please do not rely on voicemail, email, text messaging, or appointment requests for emergency assistance.

• To protect confidentiality and maintain appropriate professional boundaries, I do not accept personal friend or connection requests from clients through social media.
• I do not publicly acknowledge therapeutic relationships through comments, tags, or other online interactions.
• You are welcome to discuss any questions or concerns regarding professional boundaries or social media during sessions.

• When providing therapy to children and adolescents, I recognize the importance of both caregiver involvement and the young person's privacy.
• Parents and legal guardians may have rights regarding treatment decisions and access to information, subject to applicable state and federal laws.
• These rights may vary depending on age, consent arrangements, custody orders, and other legal circumstances.
• I strive to support developmentally appropriate confidentiality while involving caregivers in treatment when appropriate and legally permitted.
• When information needs to be shared with a caregiver, I will seek to involve the young person in that conversation whenever clinically appropriate.
• Certain safety concerns, suspected abuse or neglect, and other legally required disclosures may limit confidentiality.
• Ohio law provides limited circumstances in which minors age 14 or older may request outpatient mental health services without parental knowledge or consent, subject to specific legal requirements.
• Relevant custody, guardianship, or court documentation may be requested when appropriate.

• Clinical records are maintained in accordance with applicable professional, privacy, and record-retention requirements.
• Records may include assessments, treatment plans, progress notes, relevant communication, billing information, and other information necessary to support treatment.
• You may request access to your records, subject to applicable laws and limitations.
• Procedures for accessing, requesting amendments to, or obtaining copies of records are described in the Notice of Privacy Practices.

• Therapy may end when treatment goals have been achieved, services are no longer clinically indicated, you choose to discontinue, or circumstances make continued treatment inappropriate or impractical.
• When possible, I encourage a planned termination process to review progress, discuss remaining concerns, and identify future needs.
• When clients have not scheduled or attended appointments for an extended period, I will review the circumstances individually rather than automatically terminating services after a predetermined period.
• Factors may include treatment needs, appointment frequency, previous communication, and any arrangements previously discussed.
• If termination is appropriate, I will make reasonable efforts to provide notice, minimize disruptions to care, and offer appropriate referrals or resources when indicated.
• Financial or administrative concerns may be considered as part of this process while maintaining professional responsibilities and avoiding client abandonment.

• Connected Roots Counseling offers therapy through video communication and, when clinically appropriate, telephone sessions.
• Telehealth allows clients to participate remotely and can improve accessibility and convenience.
• Telehealth also involves potential risks and limitations, including technical interruptions, privacy concerns, and limitations in observing nonverbal communication.
• Telehealth may not be appropriate for every individual or clinical situation.

• Telehealth services are subject to applicable confidentiality and privacy protections.
• Reasonable safeguards are used to protect client information; however, electronic communication carries inherent privacy and security risks.
• Clients are encouraged to attend appointments from a private, quiet location where conversations cannot be overheard.
• Sessions should not occur while driving, operating equipment, or engaging in activities that interfere with safety or meaningful participation.
• If privacy cannot reasonably be maintained, alternative arrangements may be considered.

• Your physical location will be confirmed during telehealth sessions for safety purposes.
• You may be asked to provide or update an emergency contact and information about local emergency resources.
• If a serious safety concern arises, I may take clinically appropriate steps to coordinate emergency assistance consistent with applicable laws and professional responsibilities.
• Telehealth services are not a substitute for emergency psychiatric or medical care.

• Clients are responsible for access to an appropriate device, internet or telephone service, and a location suitable for participating in telehealth.
• If technology creates barriers to participation, please communicate these concerns so that potential solutions or alternatives can be considered.

• Technical difficulties may occasionally interrupt a scheduled session.
• If the connection is lost, we will attempt to restore communication using available and previously agreed-upon methods.
• Depending on the circumstances, this may include reconnecting through the video platform, communicating by telephone, or another appropriate arrangement.
• If the session cannot be resumed effectively, we may determine that rescheduling is necessary.
• Technical interruptions outside the client's reasonable control will not automatically be treated as missed appointments.
• An individualized backup communication plan may be established when appropriate.

• I will periodically evaluate whether telehealth continues to meet your clinical needs.
• If telehealth is no longer appropriate, we may discuss alternative services, additional support, or referrals.

• Telehealth coverage and reimbursement may vary depending on your insurance benefits, the type of service provided, and other applicable requirements.
• Applicable fees and financial responsibilities will be discussed when relevant.

• Therapy sessions will not be audio- or video-recorded without the documented permission required by applicable law.
• Optional audio-assisted clinical documentation is addressed in a separate consent section.
• Clients should not independently record sessions without discussing and obtaining appropriate permission from the therapist.

• You may ask questions about telehealth services, discuss alternatives, or withdraw your consent.
• Withdrawing consent to telehealth may affect the format or availability of continued treatment.
• Appropriate alternatives or referrals will be discussed when clinically indicated.

• Connected Roots Counseling may use technology, including artificial intelligence (AI)-assisted tools, to support clinical documentation, treatment planning, and administrative tasks.
• These tools may help organize clinical information, draft progress notes, summarize relevant material, or prepare other treatment-related documentation.
• Depending on the technology used, clinical information may be entered directly by the therapist or processed through temporary audio capture and transcription.
• The purpose of these tools is to support efficient and accurate clinical documentation.

• AI-assisted tools do not replace the therapeutic relationship, professional judgment, or clinical decision-making.
• I remain responsible for reviewing and finalizing clinical documentation and determining appropriate treatment.
• AI-generated content may contain errors or omissions and is reviewed for accuracy and clinical appropriateness.

• Protecting client privacy and confidentiality remains a priority.
• Technology used to process protected health information must be evaluated for appropriate privacy and security safeguards, including applicable HIPAA requirements and business associate agreements.
• Information processing, storage, retention, and deletion procedures may vary depending on the specific technology used.
• Information about the technology used, including relevant privacy practices and retention procedures, will be provided before obtaining consent for audio-assisted documentation.

• Approved technology may be used to organize or draft clinical information entered directly by the therapist.
• This process does not necessarily involve recording or transcribing therapy sessions.
• Any use of protected health information must comply with applicable confidentiality and privacy requirements.

• Some documentation systems may temporarily capture session audio and create transcripts or summaries to assist with clinical notes.
• Audio-assisted documentation will not be used without your documented permission.
• Audio and transcript handling may differ between platforms. Relevant processing and retention procedures will be explained before permission is obtained.
• Participation in audio-assisted documentation is optional.
• You may decline permission without losing access to therapy services. Alternative documentation methods will be used.
• You may withdraw permission for future audio-assisted documentation at any time.
• Withdrawal does not automatically remove information already incorporated into clinical records or otherwise retained as required or permitted by law.
• Material changes to the audio-assisted documentation process will be explained, and additional permission will be obtained when required.

• Technology may temporarily capture or process session audio.
• Audio may be transcribed or summarized to assist with clinical documentation.
• Data handling and retention procedures vary by platform.
• My therapist remains responsible for reviewing and finalizing clinical records.
• Audio-assisted documentation is optional.
• I may decline or withdraw permission for future sessions.
• Declining audio-assisted documentation will not prevent me from receiving therapy services.

• Connected Roots Counseling is committed to protecting the privacy and security of your health information.
• Clinical records are maintained to provide appropriate treatment, support necessary administrative activities, and comply with legal requirements.
• We follow applicable privacy laws and the terms of our current Notice of Privacy Practices.
• We will notify affected individuals of breaches of unsecured protected health information when required by law.

• Protected health information may be used or disclosed for treatment, payment, and healthcare operations as permitted by law.
• Examples include preparing clinical records, coordinating care, processing insurance claims, managing appointments, and conducting necessary practice activities.
• Certain uses or disclosures require additional authorization or are subject to stricter legal protections.

• Certain disclosures may be required or permitted by law, including disclosures related to mandated reporting, qualifying legal proceedings, health oversight, and serious safety concerns.
• Disclosures will be evaluated according to applicable legal requirements and privacy protections.
• Requests for records do not automatically authorize unrestricted disclosure.

• Psychotherapy notes, as specifically defined under HIPAA, receive additional privacy protections.
• These notes generally require authorization for uses or disclosures outside certain limited legal exceptions.
• Routine clinical progress notes maintained in the medical record are not necessarily classified as HIPAA psychotherapy notes.

• Certain substance use disorder records may receive additional protections under federal law, including 42 CFR Part 2.
• When applicable, these records will be handled in accordance with relevant privacy and disclosure requirements.

Subject to applicable law, you may have the right to:

• Request access to or copies of your health information.
• Request amendments to information you believe is incorrect or incomplete.
• Request confidential communication through a preferred method.
• Request restrictions on certain uses or disclosures.
• Request an accounting of certain disclosures.
• Obtain a paper or electronic copy of the Notice of Privacy Practices.
• Designate an authorized personal representative.
• File a privacy complaint without retaliation.

• Uses or disclosures requiring written authorization will not occur without that authorization, except when otherwise permitted by law.
• Authorizations may generally be revoked in writing, subject to applicable limitations.
• Certain disclosures to a health plan must be restricted when the applicable conditions are met and a client has paid in full out of pocket for the service.

• If you have concerns about how your information has been used, disclosed, or protected, you may contact Connected Roots Counseling's designated privacy contact.
• You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.
• Information about filing a complaint is available at https://www.hhs.gov/hipaa/filing-a-complaint/index.html.
• Connected Roots Counseling will not retaliate against you for filing a privacy complaint.

• Connected Roots Counseling may revise its privacy practices and update the Notice of Privacy Practices as permitted by law.
• The current notice will be made available upon request and through applicable practice communication channels.

• I have received and reviewed the Connected Roots Counseling Practice Policies.
• I understand the general nature, potential benefits, risks, and limitations of psychotherapy.
• I understand confidentiality protections and their limitations.
• I have been informed of appointment expectations, cancellation fees, financial responsibilities, and communication procedures.
• I understand the emergency and crisis procedures.
• I understand that I may ask questions, discuss alternatives, and participate in treatment decisions.
• I understand that telehealth and optional audio-assisted documentation require their respective consents.
• I have had the opportunity to ask questions and receive clarification.