Evolve TX Therapy Services

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PRACTICE AND PRIVACY POLICIES

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Appointments and Cancellations Policy

Appointments are scheduled in advance, at a cadence we agree on, based on your goals, treatment needs, and our mutual availability. Payments for each appointment will be made through debit or credit card or ACH transfer. You will need to have a valid credit card on file before our first appointment.

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You are responsible for communicating issues via email or phone that may interfere with attendance to the session in a timely manner. You would be considered tardy if more than 5 minutes late for an appointment, but you will still be seen if less than 15 minutes late. I will contact you via email about 5 minutes into the appointment to determine if you plan to attend the session. Tardiness of greater than 15 minutes will result in a no-show for your scheduled appointment and will be charged the no-show fee.

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You may cancel appointments in advance without charge, as long as I receive notice 24 hours before your appointment. For appointment no-shows or late cancellations (less than 24 hours notice), you may be charged a fee. No-show fees are $75 and late-cancellation fees are $50.

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Teletherapy

Please note therapy does not occur in public areas. If you will not be in a private place for the appointment, please cancel your session in advance. You must be physically located in the state where I am licensed (Texas) for the session to occur. If you will be out of state, please inform me 24 hours before the session to avoid a late-cancellation fee.

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Fiscal Responsibility

● You are responsible for paying for outstanding balances before your next scheduled session

●. Failure to pay for an outstanding balance will result in deferral of treatment until payment is received

●  No-shows and cancellation fees are not covered by insurance and will be an out of pocket expense. A credit card must be on file in order for you to see your provider.

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Insurance and Managed Care Plans:

Evolve TX Therapy Services participates in a number of insurance and managed care plans. If Evolve TX Therapy Services participates in your plan, you agree to pay all applicable deductibles, co-payments, co-insurances and any other form of cost-sharing.

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You will inform your provider if your insurance plan changes or is ending. You understand you may be responsible to pay in full for the service if this information is not provided or updated before my appointment.

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Assignment of Insurance Fees; Release of confidentiality for authorization of benefits and for clinical care:

You agree to allow your insurance plan or managed care plan to pay Evolve TX Therapy Services directly, instead of paying the Provider. In the event that your plan pays you directly, you will promptly turn the payment over to Evolve TX Therapy Services unless you have already paid the charges yourself. You authorize Evolve TX Therapy Services to provide your insurance plan or managed care plan any information reasonably required to obtain insurance benefits and authorization for services. You authorize Evolve TX Therapy Services to obtain at any time during my treatment here, any and all relevant clinical information from clinicians and facilities that have treated me and to furnish relevant clinical information to providers who will continue to treat me. You will indicate in writing any exceptions to this.

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Telephone Accessibility and Disclaimer

My office hours are standard business hours Monday through Friday and by appointment only. If you need to contact me between sessions, please leave a message on my voicemail. I am often not immediately available; however, I will attempt to return your call within 24-48 business hours.

The best way to get in touch with me is via email. At this time, I am not able to respond to text messages. I am closed on all major holidays. I DO NOT provide emergency services, crisis services, evening, weekend or after-hours coverage. If you have a life-threatening mental health emergency, please go to the nearest emergency room or call 988 immediately.

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Messaging Terms and Privacy Policy:

Messaging Terms & Conditions:

‍ You can opt-in to receive text messages by adding your phone number and selecting the box to opt-in to text message communication on the Text Message Consent Form provided to you. By opting-in, you agree to receive informational messages (appointment reminders, account

notifications, etc.) from Evolve TX Therapy Services. Message frequency varies. Message and data rates may apply. For help, reply HELP or email us at kailynn@evolvetxtherapysvcs.com. You can opt out at any time by replying STOP.

 

Mobile SMS Messaging Privacy Policy:

Information collected: We may collect information, such as name, phone number, and email address.

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Use of information collected:

We may use the information we collect to perform the services requested including billing, customer service, appointment reminders and other administrative requests.

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Sharing of information collected:

Mobile information will not be shared with third parties/affiliates for marketing/promotional purposes. This includes text messaging opt-in data and consent. As a current or prospective customer, you understand that you can text us STOP at any time to opt out of receiving SMS text messages from us. You can text us HELP at any time to receive help. You understand that the messaging frequency may vary. Messaging & data rates may apply. All policies are followed as per CTIA guidelines 5.2.1. At any time if you want your information to be removed, you can contact us via our email address or regular mail.

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Discharge Process

There are several reasons why we may eventually end our professional relationship. You may decide you would prefer to work with a different provider. I may reach the conclusion you would be better served working with someone else. Regardless of the case, I will first discuss with you the reasons for discharging, and if you request, provide you with a list of other qualified providers. I will also extend the discharge process

length if necessary based on your treatment needs, including continuing to provideemergency support for a time-limited period after you have been notified of the end of our treatment relationship.

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Please note that ongoing failure to pay for treatment, attend sessions or frequent no-shows/late-cancellations, or communicate with me in a respectful and timely manner can also result in discharge from my practice. In these instances, to ensure you have continued access to care, I will still make every reasonable effort to get in touch with you and provide referrals to a new provider before I consider our relationship ended.

If there is no communication between us for a period of three months and this absence was not previously discussed, you will be considered inactive and formally discharged from the practice.

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Privacy

I utilize a secure and confidential platform that is HIPAA compliant to conduct your sessions and exchange information. The business phone is also HIPAA compliant. I use a HIPAA-compliant platform called Mentalyc to assist with notes and documentation when able. There is a separate consent form for you to review and sign in order for me to utilize this service. Please note this service is optional.

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YOU ARE AGREEING THAT YOU HAVE READ, UNDERSTOOD AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.