1. Scope of Services & Practice Description
Healing Angels Collective-The HAC provides professional mental health counseling and psychotherapy services.
Treatment Process: Therapy involves active participation, self-reflection, and collaboration between the client and therapist.
Outcomes Disclaimer: While psychotherapy can lead to improved mental health and emotional well-being, specific outcomes cannot be guaranteed.
2. Website Opt-In Consent Disclosure (TCPA / 10DLC Compliance)
By providing your mobile phone number and submitting this form, you agree to receive text messages from Healing Angels Collective-The HAC regarding appointment scheduling, confirmations, billing, and practice announcements. Message frequency varies. Message and data rates may apply. Reply STOP to opt out or HELP for assistance. Consent is voluntary and is not required as a condition of receiving treatment. View our Privacy Policy and SMS Terms & Conditions for additional information."
[ ] I agree to receive SMS communications as described above.
Privacy & Non-Sharing Statement: Mobile information and SMS opt-in consent data will NOT be shared or sold to third parties or affiliates for marketing purposes under any circumstances.
3. Emergency & Crisis Messaging Disclaimer
"EMERGENCY NOTICE: Text messaging, email, and web contact forms are for non-urgent administrative inquiries only (scheduling, billing, general questions) and are NOT monitored 24/7. Do NOT use text messaging or contact forms for medical or mental health emergencies. If you are experiencing a mental health crisis or emergency, call 911, go to the nearest emergency room, or call/text 988 to reach the Suicide & Crisis Lifeline."
Additional Emergency Support Numbers:
United Way Helpline: (210) 227-4357 or 211
The Center for Healthcare Services: (210) 223-7233
The Crisis Intervention Hotline: (832) 416-1177
After-Hours Response Expectations:
Non-urgent messages, standard portal inquiries, or emails received outside of standard office hours (Monday through Friday, 9:00 AM to 5:00 PM CST) will generally be responded to within 24 to 48 business hours. Practice staff and clinicians do not offer immediate after-hours crisis response.
4. HIPAA Communication & Privacy Disclaimer
Standard text messaging and standard email are unencrypted communication channels and carry inherent privacy risks. Sensitive clinical details or personal medical history should not be sent via unencrypted text message or email. For secure clinical communication, please use our HIPAA-compliant client portal.
No mobile information will be shared with third parties or affiliates for marketing or promotional purposes. All other categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties.
5. Confidentiality & Legal Exceptions
All interactions with Healing Angels Collective are strictly confidential in accordance with HIPAA guidelines and ethical standards. Information will not be released without written authorization, except under the following legally mandated exceptions:
Suspected child abuse, neglect, or exploitation.
Suspected elder or vulnerable adult abuse, neglect, or exploitation.
Imminent threat of harm to self or others.
Compliance with a valid legal court order or judge-issued subpoena.
When prenatal exposure to controlled substances that are potentially harmful is disclosed.
When the client is a minor, as parents or legal guardians of non-emancipated minors have the right to access their child’s records.
Texas Board (BHEC) Complaints Notice
The Texas Behavioral Health Executive Council (BHEC) investigates and prosecutes professional misconduct committed by Texas licensed marriage and family therapists, licensed professional counselors, licensed psychological associates, licensed psychologists, and licensed clinical social workers.
If you wish to file a complaint against a licensee, you may contact BHEC at:
Website: https://www.bhec.texas.gov
Address: Texas Behavioral Health Executive Council, 1801 Congress Ave., Suite 7.300, Austin, Texas 78701
Phone: (512) 305-7700 or Toll-Free Complaint Line: (800) 821-3205
When required for insurance reimbursement.
6. Telemental Health Policies
LPC Associate & Supervisory Information
If your services are provided by a Licensed Professional Counselor Associate (LPC Associate), please be advised that LPC Associates practice under the direct supervision of a Board-Approved LPC Supervisor in accordance with Texas law.
Clinician: LPC Associate Name, LPC Associate
Board-Approved Supervisor: Brittany Stark, LPC-S
Supervisor Contact Info: brittanystark@getmanatee.com
Supervision Scope: Clinical cases and documentation are routinely reviewed with the Board-Approved Supervisor to ensure compliance with professional standards.
For clients participating in telehealth / video therapy sessions:
Client Environment: Clients must ensure they are in a private, quiet, and secure location during session to maintain confidentiality. Sessions must not be conducted while driving or in public settings.
Licensure Boundaries: Clients must be physically located within the state(s) in which the clinician is legally licensed to practice at the time of the appointment.
Technical Backup Plan: In the event of a technological disruption, the therapist will attempt to re-establish connection or contact the client via the primary phone number on file.
Telemental Health by SimplePractice: SimplePractice facilitates videoconferencing and is NOT an Emergency Service.
7. Fees, Billing, and Cancellation Policy
Fee Structure: Outlined rates apply to intake assessments, individual therapy sessions, couples counseling, and administrative tasks.
Cancellation & No-Show Policy: Cancellations or requests to reschedule must be submitted at least 24 hours prior to the scheduled appointment time. Late cancellations or missed appointments without 24 hours' notice will incur the session fee.
Payment Processing: A valid credit card or debit card must be kept on file. Card charges will be processed automatically prior to each session unless alternative payment arrangements have been made in advance.
8. Record Keeping, Client Records, and AI Scribe Consent
Record Keeping: Healing Angels Collective is the custodian of your medical records and Protected Health Information (PHI), which are stored online in a secure, encrypted, HIPAA-compliant system.
Records Requests: Records are accessible upon submission of a Records Request Form. A fee of $20.00 is charged for records requests and $5 per additional request within 1 calendar year.
Consent for AI Scribe (SimplePractice): We utilize SimplePractice's HIPAA-compliant note-taking system to generate session transcripts and summarizations. Audio recordings are not stored, and data is encrypted to ensure privacy.
[ ] I/We GRANT permission to use SimplePractice's AI Scribe recording/transcription for my/our session(s).
[ ] I/We DO NOT GRANT permission to use SimplePractice's AI Scribe recording/transcription for my/our session(s).
9. Client Acknowledgment & Consent
By signing below, I acknowledge that I have read, understood, and agree to the Terms and Conditions, Practice Policies, TCPA/10DLC Communication Disclosures, Emergency Disclosures, HIPAA Communication & Privacy Disclosures, and Telemental Health Policies outlined above.
Client Full Name: _____________________________________
Date: ________________________
[ ] I agree to the Terms and Conditions and SMS Communications as described above.
Client Signature: _____________________________________