NOTICE OF PRIVACY PRACTICES eTherapyCare This notice describes how your health information may be used and disclosed and how you can access this information. Please review it carefully. You may have additional rights under state and local law. If you have any questions regarding your rights to health care information, please seek legal counsel from an attorney licensed in your state. ACKNOWLEDGEMENT OF RECEIPT OF PRIVACY NOTICE Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have specific rights regarding the use and disclosure of your Protected Health Information (PHI). I. My Pledge Regarding Health Information Your health information is personal, and eTherapyCare is committed to protecting it. We maintain a record of the care and services you receive to provide quality care and to comply with legal requirements. This notice applies to all records of your care generated by our practice and explains how we may use and disclose your health information. It also outlines your rights concerning your information. We are legally required to keep your PHI private, provide you with this Notice of Privacy Practices outlining our legal duties, and follow the terms of this notice while it is in effect. We may revise this notice at any time, and the changes will apply to all information we maintain. A current version of this notice will always be available upon request, in our office, and on our website. II. How We May Use and Disclose Health Information About You For Treatment, Payment, or Health Care Operations HIPAA allows us to use or disclose your PHI without written authorization for Treatment: We may use and share your PHI with other healthcare providers involved in your care. For example, a clinician may consult with another healthcare professional about your diagnosis or treatment plan. Payment: We may use and disclose PHI for billing and insurance purposes. Health Care Operations: We may use your PHI for administrative purposes, such as appointment reminders, billing, and quality improvement. Disclosures for treatment are not subject to the minimum necessary standard, as providers require full access to medical information to deliver effective care. Lawsuits and Disputes If you are involved in a legal matter, we may disclose health information in response to a court order, subpoena, or other legal process, but only when required by law. III. Certain Uses and Disclosures Require Your Authorization We will obtain your written authorization before using or disclosing psychotherapy notes, except under the following circumstances: For treatment purposes, for training and supervision of mental health professionals, for legal defense in a case initiated by you, for federal compliance investigations, or as required by law. Additionally, we will not use or disclose your PHI for marketing purposes or sell your information. If you provide a testimonial or review containing PHI, you must sign a HIPAA authorization before we can publish it. You may revoke your authorization at any time by submitting a written request, though we cannot retract prior disclosures made with your consent. IV. Uses and Disclosures That Do Not Require Your Authorization We may use and disclose your PHI without your written authorization under specific circumstances, including appointment reminders and health-related benefits, legal obligations including state and federal reporting requirements, public health activities including reporting suspected abuse, health oversight activities including audits and investigations, judicial or administrative proceedings including court orders and subpoenas, law enforcement purposes including reporting crimes on our premises, medical examiner or coroner requests, research purposes under strict privacy conditions, government functions including military and national security requirements, workers’ compensation claims, and organ and tissue donation requests. V. Certain Uses and Disclosures Require Your Opportunity to Object You have the right to object to the disclosure of your PHI to family, friends, or others involved in your care. If you are unable to communicate, such as in an emergency, we may disclose relevant PHI if, in our professional judgment, it is in your best interest. VI. Your Rights Regarding Your PHI Under HIPAA, you have the following rights: The Right to Request Limits on Uses and Disclosures You may request restrictions on how we use or share your PHI. We are not required to agree to all requests, but we will consider them carefully. The Right to Restrict Disclosure for Self-Paid Services If you have paid for services out-of-pocket in full, you may request that we do not disclose your information to your insurance provider. The Right to Choose How We Contact You You may request that we contact you in a specific way, such as by phone, email, or alternate mailing address. We will comply with reasonable requests. The Right to Access Your Medical Records You may request a copy of your medical records in electronic or paper format. We will provide them within 30 days of receiving your written request, and we may charge a reasonable cost-based fee. The Right to an Accounting of Disclosures You may request a list of disclosures made in the past six years, excluding disclosures for treatment, payment, and healthcare operations. We will provide one free disclosure list per year; additional requests may incur a fee. The Right to Request Corrections If you believe your PHI is inaccurate or incomplete, you may request corrections. We will respond within 60 days and may deny your request with an explanation in writing. The Right to a Paper or Electronic Copy of This Notice You have the right to request a paper copy of this notice at any time, even if you have already received an electronic copy. The Right to Designate a Representative If you have appointed a legal representative, they may make decisions regarding your PHI on your behalf. The Right to File a Complaint If you believe your privacy rights have been violated, you may file a complaint by contacting eTherapyCare directly or filing a complaint with the U.S. Department of Health & Human Services, Office for Civil Rights at 200 Independence Avenue, S.W., Washington D.C. 20201, Phone: (877) 696-6775, Website: www.hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint. VII. Changes to This Notice We may change the terms of this notice at any time, and updates will apply to all records we maintain. The revised notice will be available in our office and on our website. If you have questions about this notice or your privacy rights, please contact us. info@eTherapyCare.com.

PRACTICE POLICIES eTherapyCare APPOINTMENTS AND CANCELLATIONS No-Show / Cancellation Policy: Refunds will not be issued for missed appointments or reschedules/cancellations within 24 hours of the scheduled appointment time. Clients may cancel or reschedule an appointment at any time via the link in their appointment confirmation email, provided they give more than 24-hour notice. If a client misses or cancels an appointment with less than 24-hour notice or fails to show up, they will not be reimbursed for the session and will be charged the full session fee. This policy is necessary because a time commitment is made to the client and held exclusively for them. If a client arrives late for a session, they may lose some of that session time. The standard meeting time for psychotherapy is 50 minutes, but the length of the session may be adjusted based on client needs. Any requests to change the session duration must be discussed with the therapist in advance to allow for appropriate scheduling. THERAPIST ACCESSIBILITY Clinicians are not available outside of scheduled session times. Any inquiries should be directed to clinic support staff, who will respond within a reasonable timeframe, taking into account weekends, evenings, holidays, and personal time. In case of an emergency, clients should call 911 or visit the nearest emergency room. SOCIAL MEDIA AND TELECOMMUNICATION Due to the importance of maintaining confidentiality and avoiding dual relationships, clinicians do not accept friend or contact requests from current or former clients on any social networking sites such as Facebook or LinkedIn. Connecting with clients on social media may compromise confidentiality, privacy, and professional boundaries. If a client has questions about this policy, they may discuss it with their clinician. ELECTRONIC COMMUNICATION All electronic communications carry a risk of interception, unauthorized access, or technical interference. While eTherapyCare follows best practices to maintain security, confidentiality cannot be fully ensured when communicating via electronic means, including text messages, direct messages, or email. If clients choose to communicate via email or text for scheduling or cancellations, they acknowledge the inherent risks. While messages will be returned in a timely manner, immediate responses are not guaranteed, and electronic communication should not be used for discussing therapeutic content or requesting emergency assistance. TELEMEDICINE POLICY Services provided via electronic means, including but not limited to telephone communication, video conferencing, email, and facsimile, are considered telemedicine in accordance with state and federal regulations. Under applicable telemedicine laws, telehealth is broadly defined as the use of technology to deliver medical and mental health services from one location to another. If a client and therapist choose to use telehealth for some or all treatment, the client retains the right to withhold or withdraw consent at any time without affecting access to future care or benefits. Existing confidentiality protections apply to telehealth sessions, and clients have the right to access all medical information transmitted during telehealth interactions. Identifiable images or information obtained during telehealth sessions will not be shared with third parties without client consent. Potential benefits of telehealth include improved access to care, increased flexibility, cost savings, and continuity of care, while potential risks include limitations in nonverbal observations, technical difficulties, and security concerns. Clients acknowledge that telehealth may limit the therapist’s ability to observe certain clinically relevant information such as physical condition, posture, facial expressions, and other nonverbal cues. Clients should discuss any concerns related to telehealth services with their therapist. MINORS If the client is a minor, parents or legal guardians may be entitled to certain information about their therapy. The therapist will discuss with the minor and their parent or guardian what information is appropriate to disclose and what should remain confidential. In cases where a minor threatens serious harm to themselves or others, or reports being harmed, the therapist is legally required to notify the parent or guardian and may need to report to the appropriate state agencies in compliance with mandated reporting laws. TERMINATION The therapeutic relationship may be terminated by either the client or clinician at any time. The appropriate length of the termination process depends on the duration and intensity of treatment, as well as the client's progress in therapy. Clinicians may terminate treatment after appropriate discussion with the client if it is determined that therapy is not being effectively utilized, is no longer beneficial, or if the client is in default of financial agreements. Clinicians will not terminate therapy without first discussing the reasons for termination and offering referrals to other qualified providers. If therapy is terminated or if a client requests a different therapist, they will be provided with a list of alternative mental health professionals. Clients may also seek their own referrals. If a client fails to schedule or attend sessions for three consecutive weeks without prior arrangements, the professional relationship will be considered discontinued for legal and ethical reasons.

CONSENT FOR TREATMENT VIA TELEHEALTH eTherapyCare I understand that my health care provider wishes me to engage in a telehealth consultation. I understand that video conferencing technology will be used for this consultation and that it will not be an in-person health care provider visit, as I will not be in the same room as my provider. I acknowledge that telehealth has potential benefits, including increased accessibility to care and the convenience of meeting from a location of my choosing. I also understand there are potential risks to this technology, including interruptions, unauthorized access, and technical difficulties. I acknowledge that either my health care provider or I may discontinue the telehealth consultation if it is determined that the videoconferencing connection is inadequate for the situation. I will reach out to clinic support staff if I have any questions regarding this procedure; otherwise, I acknowledge that I fully understand the risks and benefits of telehealth treatment. CONSENT TO USE THE HIPAA-COMPLIANT ZOOM SERVICE Zoom is the technology service that will be used to conduct telehealth videoconferencing appointments. It is simple to use, and there are no passwords required to log in. By signing this document, I acknowledge that Zoom is not an emergency service, and in the event of an emergency, I will use a phone to call 911. Though my provider and I may be in direct, virtual contact through Zoom, neither eTherapyCare nor Zoom provides any medical or healthcare services, including but not limited to emergency or urgent medical services. Zoom facilitates videoconferencing and is not responsible for the delivery of any healthcare, medical advice, or care. I do not assume that my provider has access to any or all technical information in Zoom or that such information is current, accurate, or up to date. I acknowledge that my provider is not responsible for the technical aspects of Zoom’s functionality, and I will not rely on them to provide technical support. To maintain confidentiality, I will not share my telehealth appointment link with anyone unauthorized to attend the appointment. By signing this form, I certify that I have read or had this form read and/or explained to me, that I fully understand its contents, including the risks and benefits of telehealth treatment, and that I have had ample opportunity to ask questions, all of which have been answered to my satisfaction.

NO SURPRISES ACT POLICY eTherapyCare is committed to complying with the No Surprises Act, which aims to protect clients from unexpected medical bills. As part of this commitment, all session fees are clearly displayed on the site, including but not limited to initial consultations, group sessions, individual sessions, and intensive sessions, as a means to provide Good Faith Estimates (GFEs) to all clients, including uninsured and self-pay clients, as well as any client upon request. The displayed GFE outlines the expected charges for the specific health care service being offered, helping clients make informed decisions about their care. eTherapyCare ensures that clients have the right to receive a GFE for the total expected cost of any non-emergency services. Clients have permanent access to a GFE on the same day as booking, clearly indicating the clinical provider, the primary service, the charge associated with each service or item, and the anticipated date of service. Clients acknowledge that the GFE is always presented in real-time and reflects the most accurate estimated costs available. Clients are entitled to receive a GFE for the total expected cost of any non-emergency services. Under the No Surprises Act, if the billed charges are $400 or more than the GFE, clients have the right to dispute the bill. A copy of the GFE will be retained in the client’s record, and clients are encouraged to keep a copy of their payment receipts for reference. eTherapyCare will inform clients of their right to receive a GFE by posting a notice on the website, displaying a notice in a prominent location in the office where applicable, and providing written notice to clients by way of clearly stated prices on the website. If a client is billed for an amount at least $400 more than the GFE, they may initiate a billing dispute resolution process. Clients can contact the U.S. Department of Health and Human Services (HHS) to begin the dispute process, which must be initiated within 120 calendar days of the date on the original bill. For more information, visit cms.gov/nosurprises. This policy is in accordance with the No Surprises Act and is designed to ensure transparency and protect clients from unexpected medical bills.

*I agree and attest that I have read and agree with the following: Consent To Treat, Privacy Practices, No Surprises Act, Practice Policies (including no-show and late cancelation policy).* I authorize the described mental health assessment and treatment. Authorization will be in effect until such time as this professional relationship is terminated, or until consent is revoked. Submission of this form is my written consent under the nature and terms as stated above.