Online Privacy Policy

Effective Date: September 20, 2025

SECTION 1 — NOTICE OF PRIVACY PRACTICES

PIL Professional Counseling & Psychotherapy is committed to protecting your privacy. This Notice of Privacy Practices (“Notice”) explains how we may use or disclose your Protected Health Information (“PHI”) and outlines your rights under federal law.

Your Rights

Right to Inspect and Obtain Copies

You may request to inspect or obtain electronic or paper copies of your health record. We may charge a reasonable fee for copies. Your request may be denied if releasing the information would endanger your life or the life of another person; however, you may request a review of this denial.

Right to Request Amendments

You may request corrections to PHI that is inaccurate or incomplete.
We may deny a request if:

We believe the information is correct
The record was not created by PIL
The information is not part of your designated record
The information is not permitted to be changed under law

If denied, you may submit a written statement of disagreement.

Right to Request Restrictions

You may request restrictions on how we use or disclose your PHI for treatment, payment, or healthcare operations.
We are not required to agree to restrictions, except:

If you pay out-of-pocket in full for a service and request that we do not disclose information to your insurance provider, we must honor this restriction.

Right to Confidential Communications

You may request that we communicate with you in specific ways (e.g., private phone number, email, different mailing address). We will accommodate reasonable requests.

Right to a Paper or Electronic Copy of This Notice

You may request a copy of this Notice at any time.

Our Responsibilities

PIL is required to:

Maintain the privacy of your PHI
Notify you in the event of a breach involving your PHI
Follow the terms of this Notice
Provide updates to this Notice as required by law

PHI includes information related to your physical or mental health, services received, payment information, and any data used to identify you.

Permitted Uses and Disclosures

We may use or disclose your PHI without authorization for:

Treatment. To coordinate your care with healthcare providers, laboratories, pharmacies, or referring professionals.
Payment. To bill insurance or process payments.
Healthcare Operations. For quality assessments, audits, licensing, and training.
Legal or Administrative Requirements. Including court orders, law enforcement requests, or public health duties such as reporting abuse or threats of harm.
Threats to Health or Safety. If you pose a danger to yourself or others.
Special Situations

Including:

National security
Workers’ compensation
Health oversight agencies
Coroners or funeral directors

Uses Requiring Written Authorization

We must obtain your written permission for:

Release of psychotherapy notes
Marketing communications

You may revoke your authorization at any time in writing.

SECTION 2 — HIPAA CONSENT

By signing the HIPAA Consent during intake, you acknowledge and agree to the following:

Your PHI may be used for treatment, payment, and healthcare operations, including coordination of care with healthcare professionals, insurance billing, and administrative tasks.
HIPAA allows the release of information without prior authorization in cases of emergencies, abuse or neglect reporting, public health requirements, court orders, or threats of harm.
You may request restrictions on disclosure, but PIL is not required to agree except for out-of-pocket–paid services.
You may request confidential communications through alternative means.
You may inspect or request copies of your PHI.
You may amend your PHI by submitting a written request.
You may receive a copy of the Notice of Privacy Practices.
You may withdraw consent at any time by notifying PIL in writing, except where prior disclosures have already been made.
You understand that PIL uses secure electronic systems and business associate services that comply with HIPAA privacy and security rules.

SECTION 3 — CLIENT RIGHTS

Every participant receiving services at PIL has the following rights:

Respect and Dignity

To be treated with courtesy, respect, and consideration at all times.
To have personal beliefs, cultural background, and values honored.

Access to Services

To receive services without discrimination based on race, ethnicity, religion, gender, sexual orientation, age, disability, or socioeconomic status.
To receive services, appropriate to your assessed needs.

Informed Consent

To receive complete information regarding the nature, risks, and benefits of treatment.
To participate in decisions regarding your care, including the right to refuse or discontinue services.

Privacy and Confidentiality

To have your PHI protected in accordance with federal and state laws.
To receive a Notice of Privacy Practices.
To expect clinicians to follow confidentiality laws and ethical standards.

Participation in Care

To take part in treatment planning and review.
To receive regular progress updates.
To discuss any questions or concerns.

Grievance Rights

To express concerns or complaints without fear of retaliation.
To access complaint and appeal procedures.

Safe Environment

To receive services in a safe setting free from abuse, neglect, harassment, and exploitation.
To report suspected abuse or safety concerns.

Access to Records

To inspect and obtain copies of your clinical records as permitted by law.

Emergency Rights

To receive information on how to access crisis or emergency services.

Termination of Services

To be informed of any planned termination.
To receive referrals to alternative providers when appropriate.

SECTION 4 — CONSENT FOR SERVICES

By beginning services at PIL Professional Counseling & Psychotherapy (“PIL”), you provide informed consent to participate in mental health treatment delivered by qualified licensed professionals or supervised clinicians. This section explains what treatment involves, what to expect, and the limits of confidentiality.

Nature and Purpose of Services

Services may include, but are not limited to:

Diagnostic assessments
Individual counseling
Family or couples counseling
Group psychotherapy
Psychoeducation
Treatment planning
Referral and care coordination
Collaboration with other healthcare professionals
Crisis intervention when appropriate

The purpose of treatment is to support emotional healing, improved functioning, healthier coping skills, and increased well-being. Treatment plans are individualized based on your needs and collaboratively developed with your clinician.

Client Responsibilities

As a participant in services, you agree to:

Provide complete and accurate information about your health, history, and symptoms
Participate actively and honestly in treatment
Work collaboratively with your provider
Attend scheduled appointments or provide timely cancellations
Inform your provider of changes in medication, health status, or major life events relevant to treatment
Follow safety instructions and recommendations
Treat staff and other clients with respect

You may discontinue services at any time. If you choose to terminate therapy, PIL encourages you to discuss this with your clinician so appropriate support, planning, and referrals may be completed.

Confidentiality and Its Limits

Your information is confidential as required by federal and state law. However, confidentiality is not absolute. Your clinician must disclose information in the following circumstances:

Danger to Self

If you present a serious and imminent risk of harming yourself, your clinician is legally required to take steps to ensure your safety. This may include contacting emergency services, crisis responders, or designated support persons.

Danger to Others

If you make credible threats of harm against another person, your clinician may be required to notify potential victims and law enforcement.

Abuse or Neglect

Clinicians are mandated reporters. They must report known or suspected abuse or neglect of:

Children
Elder adults
Adults with disabilities

Reports go directly to appropriate protective agencies.

Court Orders

A judge may require a clinician to provide information or testify. PIL will attempt to notify you of legal contacts whenever possible.

Health Oversight Activities

Regulatory agencies may review records to ensure compliance with laws and professional standards.

Insurance Requirements

Insurance companies may require disclosure of diagnoses, treatment dates, or limited clinical information to authorize or pay for services.

Counseling Minors

Virginia law grants parents/guardians access to the treatment information of minors. However, clinicians may choose to protect some information to preserve the therapeutic relationship unless:

The minor is unsafe
Abuse or neglect is suspected
Disclosure is legally required

Parents will be notified of any safety concerns.

Record Keeping

PIL uses TherapyNotes®, a secure electronic health record system that meets HIPAA standards. Records include:

Assessments
Treatment plans
Progress notes
Communication logs
ROI documentation
Financial and scheduling information

Records are retained in compliance with legal and ethical requirements.

You have the right to request access to your records unless disclosure compromises your safety or the safety of others.

Communication Policy

PIL communicates using:

Phone calls
Voicemail
Text messaging
Email
Patient portal messaging

Important: Text and email are not guaranteed to be fully secure. Sensitive information should be shared through the portal or by phone.

PIL cannot guarantee immediate responses. Messages are reviewed during business hours only. In emergencies, do not rely on voicemail or email—call 911 or go to the nearest emergency department.

Social Media Policy

To protect your confidentiality and maintain professional boundaries:

Clinicians will not “friend,” “follow,” or engage with clients on social media
Clinicians will not respond to reviews, comments, or online discussions
Communication must occur through approved methods only

This protects your privacy and ensures ethical therapeutic boundaries.

Financial Responsibility

You are financially responsible for:

Copays
Coinsurance
Deductibles
Self-pay rates
Fees for missed or late-canceled appointments when applicable

A valid payment method must be kept on file. See Section 9 — Financial Policy for full details.

Potential Risks of Counseling

Participation in counseling may cause:

Emotional discomfort
Temporary increases in distress
Discussion of difficult or sensitive topics
Changes in relationships
Shifts in daily functioning as part of the growth process

Your clinician will support you through challenges and will work collaboratively to ensure that treatment remains safe and beneficial.

Potential Benefits of Counseling

Benefits may include:

Reduced distress
Improved emotional regulation
Increased coping skills
Enhanced communication
Better relationships
Clarified personal values, goals, and priorities
Greater resilience and sense of well-being

However, no specific outcomes can be guaranteed.

Termination of Services

Reasons for ending services may include:

Completion of treatment goals
Referral to a higher level of care
Repeated missed or late-canceled appointments
Non-compliance with treatment recommendations
Violations of safety policies
Client request

Clients will receive appropriate referrals when needed.

SECTION 5 — TELEHEALTH, DIGITAL SOFTWARE, OBSERVATION & AI NOTE-TAKING

This section includes:

Telehealth definition, purpose, and scope
Expected benefits
Potential risks
Your rights when receiving telehealth services
Consent requirements and withdrawal rights
Use of digital software and third-party platforms
Observation and recording consent
AI-assisted note-taking consent
Privacy protections and security standards

Consent For Use of Telehealth

Telehealth involves the use of electronic communications to enable providers at different locations to share individual client information for the purpose of improving client care. Providers may include primary care practitioners, specialists, and/or subspecialists. The information may be used for diagnosis, therapy, follow-up and/or education, and may include any of the following:

Client health records
Live two-way audio and video
Output data from health devices and sound and video files

Electronic systems used will incorporate network and software security protocols to protect the confidentiality of client identification and imaging data and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.

Expected Benefits:

Improved access to care by enabling a client to remain in his/her provider’s office (or at a remote site) while the providers obtains test results and consults from practitioners at distant/other sites.
More efficient client evaluation and management.
Obtaining expertise of a distant specialist.

Possible Risks:

There are potential risks associated with the use of telehealth. These risks include, but may not be limited to:

In rare cases, information transmitted may not be sufficient (e.g. poor resolution of images) to allow for appropriate decision making by the providers and consultant(s);
Delays in evaluation and treatment could occur due to deficiencies or failures of the equipment;
In very rare instances, security protocols could fail, causing a breach of privacy of personal health information;
In rare cases, a lack of access to complete health records may result in interactions or allergic reactions or other judgment errors;

By signing this form, I understand the following:

I understand that the laws that protect privacy and the confidentiality of health information also apply to telehealth, and that no information obtained in the use of telehealth which identifies me will be disclosed to researchers or other entities without my consent.
I understand that I have the right to withhold or withdraw my consent to the use of telehealth in the course of my care at any time, without affecting my right to future care or treatment.
I understand that I have the right to inspect all information obtained and recorded in the course of a telehealth interaction, and may receive copies of this information for a reasonable fee.
I understand that a variety of alternative methods of health care may be available to me, and that I may choose one or more of these at any time. My provider has explained the alternatives to my satisfaction.
I understand that telehealth may involve electronic communication of my personal health information to other practitioners who may be located in other areas, including out of state.
I understand that it is my duty to inform my provider of electronic interactions regarding my care that I may have with other healthcare providers.
I understand that I may expect the anticipated benefits from the use of telehealth in my care, but that no results can be guaranteed or assured.

Consent To Observe and Record Sessions

I understand that my assigned clinician at PIL Professional Counseling & Psychotherapy, at 522 S. Independence Blvd., Ste. 102D, Virginia Beach, VA 23452 may record sessions via video and audio, and have counselors observe sessions strictly for the purpose of education, training, and consultation among PIL staff. All observers are bound by the same confidentiality rules as those applicable to the primary clinician.

I understand that refusal to participate in audio recordings, video recordings, or observations will NOT affect my eligibility for receiving services at this agency in any way.

I agree and consent to be recorded by audio, video, or observed for educational, training, and consultation purposes.*

Yes

Consent For Use of AI Note-Taking Software

As part of their ongoing commitment to provide the best possible service, your provider has opted to use an artificial intelligence note-taking tool that assists in generating clinical documentation based on your sessions. This allows for more time and focus to be spent on our interactions instead of taking time to jot down notes or trying to remember all the important details. A temporary recording and transcript or summary of the conversation may be created and used to generate the clinical note for that session. Your provider then reviews the content of that note to ensure its accuracy and completeness. After the note has been created, the recording and transcript are automatically deleted.

This artificial intelligence tool prioritizes the privacy and confidentiality of your personal health information. Your session information is strictly used for the purpose of your ongoing medical care. Your information is subject to strict data privacy regulations and is always secured and encrypted. Stringent business associate agreements ensure data privacy and HIPAA compliance. Please discuss any questions or concerns you may have about this feature with your provider.

I give my consent to the use of artificial intelligence as described. You acknowledge that your participation is voluntary and not a condition of receiving services from your clinician, and that you can withdraw your consent.*

SECTION 6 — SCHEDULING, ATTENDANCE & CANCELLATION POLICY

PIL Professional Counseling & Psychotherapy operates by scheduled appointments. Your appointment time is reserved specifically for you. Consistent attendance is essential for therapeutic progress, and these policies ensure that care remains accessible and fair to all clients.

Appointment Expectations

Clients and clinicians are allowed a 10-minute grace period from the scheduled start time.
If you arrive more than 10 minutes late, the appointment may need to be rescheduled and may be documented as a no-show.
Clinicians may also be delayed due to emergency client needs; if this occurs, your session time will be preserved or rescheduled promptly.

Cancellation Policy for Private Insurance, Self-Pay, and EAP Clients

You must provide at least 24 hours’ notice to cancel or reschedule an appointment.

A $25 fee will be charged for:

Late cancellations (less than 24 hours’ notice)
No-shows (missed appointments without notice)

Fee Details:

The fee applies even if the appointment is rescheduled.
The fee applies regardless of the reason for the missed appointment, including work or transportation issues.
Insurance does not cover cancellation fees; they are your responsibility.
Fees are automatically charged to the payment method on file.

Repeated Missed Appointments

If you accumulate multiple late cancellations or no-shows within 30 days, PIL may:

Review your treatment plan
Suspend services temporarily
Terminate services due to non-compliance

Your clinician will make every effort to discuss concerns prior to termination.

Cancellation Policy for Medicaid Clients

Under Medicaid regulations:

Medicaid clients cannot be charged cancellation or no-show fees.
However, consistent attendance is required for continued services.

Termination for Repeated Missed Sessions

Two (2) late cancellations or no-shows within a 30-day period will result in termination of services.
Clients may reapply for services in the future or receive referral options.

How to Cancel an Appointment

You may cancel or reschedule by:

Phone call
Voicemail
Text message
Email
Secure portal message

All messages are time-stamped and accepted as valid notice.

Inclement Weather

PIL may close due to severe weather. If the office closes or your clinician is unable to travel safely:

You will be contacted
Sessions may be moved to telehealth if appropriate
Fees will not apply when PIL is responsible for cancellations

Extended Absences

If you anticipate being unable to attend sessions for more than four (4) consecutive weeks, please notify your clinician so:

Your treatment plan can be updated
Scheduling adjustments can be made
Continuity of care can be maintained

SECTION 7 — FINANCIAL POLICY

This financial policy outlines your responsibilities regarding payment for services. It is derived from your Consent for Services, Insurance Form, and Payment Authorization Form.

Insurance Coverage

If you use insurance for services, you must:

Provide accurate and up-to-date insurance information
Notify PIL immediately of any insurance changes
Understand your benefits, including copays, deductible, and coinsurance obligations

Insurance companies may request documentation or treatment information before authorizing payment. PIL complies with these requests as permitted by law.

If Insurance Denies or Delays Payment

You are financially responsible for:

Any services not covered by insurance
Services applied to your deductible
Copay and coinsurance amounts
Sessions denied due to inactive insurance

If your insurance becomes inactive, sessions will be billed at the self-pay rate until coverage is restored.

Self-Pay Rates

$155 — 60-minute session
$120 — 45-minute session
$85 — 30-minute session

Payment is due at the time of service.

Payment Method on File

PIL requires all clients to maintain a valid payment method on file.

Your card will be used for:

Session fees
Copays, coinsurance, deductibles
Late cancellation fees
No-show fees
Any outstanding balances

Security of Payment Information

PIL does not store your full card number
Payments are processed through a secure, HIPAA-compliant merchant system
You may update your payment method at any time

Outstanding Balances

Balances not paid within thirty (30) days may:

Accrue late fees
Result in suspension of services
Be referred to collections as a last resort

PIL will make reasonable attempts to contact you before taking any adverse action.

Good Faith Estimates (No Surprises Act)

If you are uninsured or choose not to use insurance:

You are entitled to a Good Faith Estimate outlining anticipated treatment costs
Actual costs may vary depending on treatment needs
You may dispute charges significantly exceeding the estimate

Returned Payments

Returned or declined payments may incur:

Processing fees
Temporary suspension of services until resolved

SECTION 8 — COMMUNICATION, ELECTRONIC MESSAGING & SOCIAL MEDIA POLICY

Effective communication supports safe and ethical treatment. This section outlines acceptable methods and the boundaries required to maintain confidentiality and professional standards.

Accepted Communication Methods

You may contact your clinician through:

Phone
Voicemail
Email
Text messaging
Secure client portal messaging

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.

Important Security Notice

Electronic communications (text/email) are not guaranteed to be fully secure. Avoid sending sensitive information electronically.

The portal is the preferred method for private messages.

Response Times

Messages are checked during business hours only:

Monday through Friday
9:00 AM to 4:00 PM

PIL does not provide 24/7 crisis response.

Emergencies

If you are experiencing a crisis, do not rely on voicemail, email, or text.
Instead:

Call 911
Visit the nearest emergency department
Contact the Crisis Hotline: 988

Video and Phone Sessions

Telehealth sessions must be conducted in:

A private location
With minimal distractions
With stable internet/phone service

Clients may not participate while driving. Sessions will end if safety is compromised.

Social Media and Online Boundaries

To protect your confidentiality and uphold ethical standards:

Clinicians will not accept friend requests
Clinicians will not follow, like, or engage with your social media content
Clinicians will not respond to online reviews, comments, or public postings
Clients should not include clinicians in personal online communications

These boundaries prevent dual relationships and protect your privacy.

SECTION 9 — COMPLAINTS & GRIEVANCES

PIL encourages clients to voice concerns. You have the right to make a complaint without fear of retaliation.

What Can Be Reported

Concerns about your rights
Quality of care
Provider behavior
Safety issues
Discrimination
Privacy violations
Billing concerns
Environmental issues
Any matter affecting your well-being

How to File a Complaint

You may submit a complaint:

Verbally
In writing
By email
Using the Complaint/Grievance Form (Appendix B)
Directly to PIL leadership

Investigation Process

Your complaint is documented and assigned a review file.
A designated reviewer investigates the concern.
Interviews may be conducted as needed.
Findings are documented.
Corrective actions are implemented if appropriate.
You will receive communication regarding the outcome.

Possible outcomes:

Resolved
Partially resolved
Not resolved (with explanation)

Non-Retaliation Guarantee

PIL strictly prohibits retaliation against any person who files a complaint or participates in an investigation.