practice does permit me to offer sliding scale rates based on your current income status, and we will establish this rate in our initial session together. Emergency phone calls are included in your service rates. However, if we spend more than 10 minutes in a week on the phone, or if you leave more than ten minutes worth of phone messages in a week, I must document my services time responding to these calls, and our practice will charge you on a prorated basis for that time. I am often not immediately available by telephone. At these times, you may leave a message on my confidential voice mail and your call will be returned as soon as possible, but it may take a day or two for non-urgent matters. If you feel you cannot wait for my return call and you perceive it is an emergency situation, go to your local hospital or call 911.

## Complaints

If you are not satisfied with our work together, please talk with me about it in our sessions so that we can address these concerns together. I take these concerns seriously. If you believe that I have been unwilling to listen or respond appropriately, or that I have behaved unethically, you can register a complaint to my clinical supervisor, Mr. Guy Strawder, LMFT, LPC, 282 Choptank Road, Suite 103, Stafford, Virginia 22556, or telephone (540) 602-2545, ext. 1007.

## My Responsibilities to You as Your Counselor

My responsibilities to you as a client include your rights to confidentiality, proper disposition of your treatment records, protection of personally identifiable information and personal health information, and the provision of services within my scope of training and appropriate to your diagnosis.

## Confidentiality

With the exception of specific situations that are described below, you have the absolute right to the confidentiality of your therapy. You are protected under the provisions of the 1996 Federal Health Insurance Portability and Accountability Act (HIPAA) which ensures the confidentiality of all electronic transmission of information about you. Whenever I transmit information about you electronically (e.g., sending bills or faxing information), it will be done with special safeguards to ensure your confidentiality. If you elect to communicate with me through the office email, please be aware that email is not completely confidential. Please do not send urgent or emergency messages through email. All emails are retained in the repositories of our respective internet service providers. While under normal circumstances no one reviews these repositories, they are technically available to be read by the system administrator(s) of the internet service provider. Any email or text message I receive from you, and any responses that I send to you, will be kept secure on a password-protected device.

In addition, I cannot and will not tell anyone else what we discuss, or even that you are in therapy with me, without your prior written permission. Under the provisions of the 1996 HIPAA Standards for Privacy of Individually Identifiable Health Information (“Privacy Rule”), I may legally speak to another health care provider or a member of your family about you without your prior consent, but I will not do so unless the situation is an emergency. I will always act to protect your privacy even if you provide your written consent to share information about you. You may direct me to share information with whomever you chose, and you can change your mind and revoke that permission at any time. You may request that another person attend a therapy session with you and we can discuss the potential advantages and drawbacks, but I ask that, as a courtesy and to prepare accordingly, that you notify me of this wish at least 24 hours in advance.