Privacy Policies

(Last Updated 1/29/2025) 

While this summary is designed to provide an overview of confidentiality and its  limits, it is important that you read this Privacy Policy Notice which was provided to you for more detailed explanations, and discuss with the Provider any questions or concerns you may have. 

For all emergencies please utilize 911, 411, 211 (community resources), 988 (mental health crisis). 

Engaging in services with this provider means that you voluntarily request and consent to behavioral health assessment, care, treatment, or services and authorize the Provider to provide such  care, treatment or services as are considered necessary and advisable. I understand  the practice of behavioral health treatment is not an exact science and acknowledge  that no one has made guarantees or promises as to the results that I may receive. By signing this Informed Consent to Treatment Form, I acknowledge that I have  both read and understood the terms and information contained herein. By signing  this Informed Consent to Treatment Form, I agree to make all payments for  services at the time services have been rendered and in the event that I fail to make  payment, I accept responsibility for resolving payment before my next  appointment or have my debt be sent to collections. 

Ample opportunity has been offered to me to ask questions and seek clarification  of anything unclear to me. 

Mandated Reporting

When there is suspicion that a child or elder is being sexually or physically abused, or is at risk of such abuse, my Provider is legally required to take  steps to protect the child, and to inform the proper authorities. 

When a valid court order is issued for medical records,  Provider is  bound by law to comply with such requests. 

Email/Text Consent 

By engaging with any contact information on this site you are consenting to recieve text meassages or emails from (the "Provider") and their agents on your cell phone or other devices. Please understand that text messages and emails sent by the Provider may include appointment reminders or changes in previously scheduled appointments, or may provide advice or  education. 

Provider does not charge for this service, but understand that standard text  messaging rates may apply as provided in your wireless plan. You may contact my carrier for pricing plans and details. 

You may revoke your request for further communications via text or  email at any time by notifying my Provider in writing. 

However, if you continue to communicate with the Provider via text or email, the  Provider can assume that consent remains valid. 

Because e-mails sent over the Internet or texts sent over the control channel without  encryption are not secure, please understand the risks associated with e-mail and text messaging, including, without limitation, that e-mails and text messages could be  intercepted by unknown third parties; e-mail content can be changed without the  knowledge of the sender or receiver; backup copies of e-mail may still exist even  after the sender and receiver have deleted the messages; and e-mail can contain  harmful viruses and other programs. 

Deleting all text messages or emails as  soon as possible after reviewing them is an option to limit any unauthorized  exposure. 

Any information that you submit to the provider will not be surrendered/shared to any third party providers unless this provider is given consent. You may opt out of any engagements at any time.

What is Telehealth? 

Telehealth is healthcare provided by any means other than a face-to-face visit. In  telehealth services, medical and mental health information is used for diagnosis,  consultation, treatment, therapy, follow-up, and education. Health information is  exchanged interactively from one site to another through electronic  communications. Telephone consultation, videoconferencing, transmission of still  images, e-health technologies, patient portals, and remote patient monitoring are  all considered telehealth services 

I hereby consent to participate in telehealth with, the Providers of Interconnection  Wellness LLC (“Provider”), as part of my care. 

I understand that telehealth is the practice of delivering clinical health care services  via technology assisted media or other electronic means between a practitioner and  a client who are located in two different locations. 

No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. All other categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties

Documentation

All requested documentations (outside of therapy notes) that are in need of provider's completion is expected to be completed in session. Any documentation requested outside of session or for non current clients will be provided within 7 business days from the request date and will be charged $20 per page. 

Provider Protection

In the event that we find that a provider feels justifiably uncomfortable with continuing to engage with a client, services will be immediatley terminated without discussion and there will be no refunds for monies paid. Clients who attempt to establish unhealthy, threatening, and/or abusive dynamics with providers will instantly be placed on the DO NOT RETURN LIST and it will be up to the provider's discretion as to their interest in pressing legal charges against the client, however the company will file for attempted manslaughter on belhalf of the client. Client may not be transferred to another provider in the event of this dynamic occurring. 

Consultation Requests

It is our expectation that if the potential client is scheduling a consultation request that they are committed to following through with the appointment.  Clients will be provided with a link for a video session via zoom. Clients are expected to show up to appointments on time and are asked to give the provider a 5 min window for session to begin. Appointment will be considered cancelled 10 mins after scheduled time. If client does not show to their appointment, they are expected to reschedule on their own free will and they will not be contacted by the provider. After 2 reschedules, client will be asked not to return. Consultations are currently $30 and will change as the company sees fit. All consultations must be paid within 24hrs of the scheduled consultations i.e.--if you schedule on Monday at 3pm then you must provide payment within by Tuesday at 3pm. Anything after 3:10pm will be cancelled moving forward. Please reach out with any needs for reschedules. There are no refunds for appointments that need to be cancelled after 2 reschedules or immediately. If there is a reschedule on the behalf of the provider, they will provide the client with 2 opportunities to reschedule the appointment in the 4 week time period.  Consultations will be scheduled by email or text message. Consultation requests will be cancelled if the potential client does not reach out after 48hrs of the message from provider. It is up to the provider's discression as to how often they would like to attempt to reengage the potential client.

Cancellation/No-shows/Reschedules

Appointments must be cancelled within 24hrs of the scheduled appointment. (i.e. if you have an appointment on Thursday at 3pm, then is a hard stop time of needing to cancel by 3pm on Wednesday). Appointment will be considered cancelled 10 mins after the scheduled time. Clients will be charged a noshow fee at the full self-pay cost (currently $220) for the session for all appointments noshow/late/cancelled after the 24hr grace period. After 2 consecutive cancellations or if a client shows a pattern of not being able to commit to scheduled sessions regularly, then their remaining sessions will be cancelled and they will be placed on a waitlist for services. There are no rescheduling appointments unless provider has additional appointment availability during the week. Clients deemed as unresponsive at any point of treatment will be immediatley discharged from services. Clients will be expected to research alterntate forms of behavioral/mental health therapy on their own if they abandon services provided by Interconnection Wellness Staff on their own.  

Legal Representation for court appearances 

Costs are as follows: $350/1 hr, $800/5hrs, $250/hr any additional hour after 5+hrs. Rates are based on a per day basis. Costs due before services are rendered. If time spent in court surpasses expected timeframe, remaining costs are due upon completion of service date. Therapists respond to court appearances subpoenaed by a Judge only. 

Refunds

There are no refunds for services provided under any circumstances. Payment is expected upon completion of the services. Payment is required for all scheduled sessions and the client is responsible for presenting to all agreed upon sessions per coaching agreement;  there are no refunds regardless if client presents to sessions. Costs per session will not be decreased if client misses a session in the agreed upon packaged. Packages expire at the end of 4 weeks and can be extended up to a 6 month duration without a new client agreement being put in place. Client agreements must be filed every 6 months and payment must begin on the day that agreement is signed. Client has the right to cancel services at any time, however, they will not be refunded for any monies paid. If auto payment stops, then services will not continue until auto payment is made.

Autopay

Services are expected to be paid by the end of the session. Clients are expected to keep a card on file to pay all copays and cancellation fees as needed and will be charged with notification to the client.  If a balance is on file, clients will be briefly terminated from services until balance is reconciled.