As a patient being treated in our practice, you have a right to:
- Receive respectful treatment that will be helpful to you
- Receive a particular type of treatment or end treatment without obligation or harassment
- A safe environment, free from abuse
- Report unethical or illegal behavior by a clinician
- Ask questions about your therapy
- Request and receive full information about the clinician’s credentials
- Have written information about fees, methods of payment, insurance reimbursement, and cancellation policies before beginning treatment
- Refuse electronic recording, but may request it if you wish
- Know the limits of confidentiality and the circumstances under which a clinician is legally required to disclose information to others
- Request a transfer of a copy of your file to any clinician or agency you choose
- Receive a second opinion at any time about your treatment
- Request that the clinician inform you of your progress
- Receive a copy of this form
- Have your privacy respected at all times.
Our Notice of Privacy Practices describes potential uses and disclosures of your health information by our practice and outlines your behavioral health privacy rights. Please read it carefully. For questions, please contact our Privacy Officer at (216) 520-5969.
By signing below you are indicating that you have read and am aware of your patient and privacy rights and that you have received a copy of Affiliates‘ Notice of Privacy Policies.
