Your Privacy Matters

Your trust is one of our greatest responsibilities.

Federal law requires healthcare providers to protect the privacy of your health information. This Notice explains how your Protected Health Information (PHI) may be used, when it may be shared, and the rights you have regarding your records.

We May Use Your Information To:

• Provide counseling services

• Coordinate your care

• Obtain payment for services

• Comply with legal obligations

• Improve the quality of our practice

We Will Never:

• Sell your personal information

• Share your information for marketing without your written permission

• Discuss your care with others unless you authorize it or the law requires it

Your Rights Include:

✔ Request a copy of your records

✔ Request corrections to your records

✔ Request confidential communications

✔ Request restrictions on certain disclosures

✔ Receive an accounting of disclosures

✔ File a complaint without fear of retaliation

Situations Where Disclosure May Be Required

While counseling is confidential, there are limited situations where disclosure may be required by law, including:

• Suspected abuse or neglect

• Court orders

• Serious threats of harm to yourself or others

• Medical emergencies

• Other circumstances required by federal or North Carolina law

Questions regarding your privacy are always welcome.

Your Right to Know the Cost of Care

Under the No Surprises Act, clients who do not have insurance or choose not to use insurance have the right to receive a Good Faith Estimate before services begin.

A Good Faith Estimate outlines the expected cost of your counseling services.

Your estimate will include anticipated fees based on the services discussed during scheduling.

Please note:

Actual costs may vary if treatment needs change.

You may request an updated estimate at any time.

If your final bill is substantially higher than your estimate, federal law provides a dispute resolution process.

If you have questions about your estimate, simply ask—we're happy to explain it.

Appointments

Appointments are scheduled by reservation to ensure each client receives uninterrupted care.

If you are unable to attend your appointment, we kindly request at least 24 hours' notice.

Late cancellations or missed appointments may be subject to a cancellation fee.

Payment

Payment is due at the time of service unless other arrangements have been made.

Accepted forms of payment include:

• Credit/Debit Cards

• Cash

• HSA/FSA cards (when applicable)

myTarapy is currently a private-pay practice and does not bill insurance directly.

Receipts or superbills are available upon request for clients seeking possible out-of-network reimbursement.

Emergencies

myTarapy is not a crisis center.

If you are experiencing:

• thoughts of suicide

• thoughts of harming others

• a medical emergency

Call 911, go to your nearest emergency room, or contact the 988 Suicide & Crisis Lifeline immediately.

Email, voicemail, and website messages should never be used during emergencies.

Communication

Email and text messaging are intended for scheduling and administrative communication only.

Because these methods are not always secure, please avoid sending confidential clinical information electronically.

Therapy Dog

Toby, our Chief Hope Officer & Wagmaster (CHOW), may occasionally participate in counseling sessions.

Participation is always voluntary.

Clients may request sessions without Toby at any time.

Social Media

To protect client confidentiality and maintain professional boundaries, myTarapy does not accept friend requests from current clients on personal social media accounts.

Telehealth

Telehealth appointments are conducted using secure, HIPAA-compliant technology whenever possible.

Clients are encouraged to attend sessions from a quiet, private location to maximize confidentiality.

Your Rights

As a client of myTarapy, you have the right to:

✔ Be treated with dignity and respect.

✔ Participate in treatment planning.

✔ Ask questions about your care.

✔ Decline any intervention.

✔ Receive confidential services within legal limits.

✔ Be informed of fees before services begin.

✔ Receive culturally respectful, non-discriminatory care.

✔ File concerns or grievances without retaliation.

Your Responsibilities

We ask clients to:

• Arrive on time.

• Participate honestly in treatment.

• Notify us of scheduling changes promptly.

• Respect office policies.

• Maintain current contact information.

• Treat staff and other clients respectfully.

Healing is a partnership, and your active participation is an important part of the process.

We're here to help.

myTarapy, LLC

📍 1840 Eastchester Drive, Suite 106
High Point, NC 27265

📞 (336) 278-1918

✉ info@mytarapy.org