Practice & Privacy Policies

Session Time & Scheduling

The standard meeting time for psychotherapy is 50 minutes. If you wish to change the length or frequency of your sessions, please discuss this with your therapist in advance so time can be scheduled appropriately.

If you are more than 10 minutes late for a session, you may lose that time, as the session will still need to end at the originally scheduled time.

Cancellation Policy and Fees

A time commitment is made to you and is held exclusively for you. Therefore, we require adherence to the following cancellation policy:

  1. Advance Notice (24+ Hours): There is no charge for appointments cancelled or rescheduled with at least 24 hours' notice.

  2. Same-Day Cancellation (Less than 24 Hours): A $50 fee will be charged if your appointment is cancelled or rescheduled with less than 24 hours' notice.

  3. No-Show: You will be responsible for the full session rate fee in the case of a no-show for your appointment. An appointment is considered a no-show if you do not arrive and notice has not been given to the therapist before the start of the appointment time.

Communications

TELEPHONE ACCESSIBILITY: If you need to contact me between sessions, please leave a message on the business voice mail or send an e-mail. I am often not immediately available; however, I will attempt to return your outreach within 24-48 business hours. If a true emergency situation arises, please call 911 or any local emergency room.

SOCIAL MEDIA AND TELECOMMUNICATION: Due to the importance of your confidentiality and the importance of minimizing dual relationships, I do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc.). I believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. If you have questions about this, please bring them up when we meet and we can talk more about it.
Electronic Communication (Text/Email)

I cannot ensure the confidentiality of any form of communication through non-secure electronic media, including standard text messages and email.

If you choose to communicate via email or text messaging, please understand:

  • Content is Limited: These methods should only be used for administrative issues like scheduling, cancellations, or brief logistical questions.

  • No Therapeutic Content: Do not use text or email to discuss clinical or therapeutic material. Doing so compromises your privacy and the safety of our work.

  • No Emergencies: I cannot guarantee immediate responses. Do not use these methods for emergencies. If a crisis arises, please call 911 or visit your local emergency room.

Telehealth Services (Video/Phone Sessions)

If we choose to hold sessions via secure video or phone:

The primary risk of telehealth is the loss of non-verbal, contextual information that is naturally present in an in-person setting. While I will use my best clinical judgment, important data points (like posture shifts, facial micro-expressions, or subtle physical distress) may be harder to observe, which could occasionally impact my clinical assessment or interventions.

By proceeding with telehealth sessions, you agree to:

  1. Ensure Privacy: Attend the session from a private, secure location where you cannot be overheard or interrupted. Use headphones if possible.

  2. Maintain Focus: Do not engage in other activities (e.g., driving, shopping, performing chores) during the session.

  3. Use Only Approved Technology: We will use a HIPAA-compliant platform for our video sessions to maximize the security of our communication.

TERMINATION
Ending relationships can be difficult. Therefore, it is important to have a termination process in order to achieve some closure. The appropriate length of the termination depends on the length and intensity of the treatment. I may terminate treatment after appropriate discussion with you and a termination process if I determine that the psychotherapy is not being effectively used or if you are in default on payment. I will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. If therapy is terminated for any reason or you request another therapist, I will provide you with a list of qualified psychotherapists to treat you. You may also choose someone on your own or from another referral source.

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Circle City Alliance Therapy & Consulting

Phone: 317-360-5864 | Fax: 317-271-5038

EFFECTIVE DATE OF THIS NOTICE: January 1, 2026 (Revised)

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. MY PLEDGE REGARDING HEALTH INFORMATION

I understand that health information about you and your health care is personal. I am committed to protecting your health information. I create a record of the care and services you receive to provide quality care and comply with legal requirements. This notice applies to all records generated by this mental health practice.

I am required by law to:

  • Ensure that protected health information (“PHI”) that identifies you is kept private.

  • Give you this notice of my legal duties and privacy practices.

  • Notify you following a breach of your unsecured PHI.

  • Follow the terms of the notice currently in effect.

I reserve the right to change the terms of this Notice. The new Notice will apply to all information I have about you. Revised notices will be available upon request, in my office, and on my website.

II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

For Treatment, Payment, or Health Care Operations: I may use or disclose your PHI without your written authorization for:

  • Treatment: Coordinating care with other providers (e.g., consulting with your psychiatrist).

  • Payment: Seeking reimbursement from health plans.

  • Health Care Operations: Quality assessment, audits, and business planning.

Prohibition on Reproductive Health Care Disclosures (2026 Update): I will not use or disclose your PHI to investigate, prosecute, or impose liability on any person for the mere act of seeking, obtaining, providing, or facilitating lawful reproductive health care.

Lawsuits and Disputes: If you are involved in a lawsuit, I may disclose PHI in response to a court order. I may disclose PHI in response to a subpoena only if efforts have been made to tell you about the request or to obtain a protective order.

III. USES AND DISCLOSURES REQUIRING YOUR AUTHORIZATION

Psychotherapy Notes: Most uses and disclosures of "psychotherapy notes" require your written authorization, except for my own use in your treatment, defense in legal proceedings brought by you, or as required by law (such as oversight by the Secretary of HHS). Marketing and Sale of PHI: I will never sell your PHI or use it for marketing purposes without your explicit written authorization.

IV. USES AND DISCLOSURES NOT REQUIRING AUTHORIZATION

Subject to certain legal limitations, I may disclose PHI without authorization for:

  • Public Health: Reporting suspected child, elder, or dependent adult abuse/neglect (Mandatory under Indiana Law).

  • Safety: Preventing a serious threat to the health or safety of yourself or others.

  • Law Enforcement: Reporting crimes occurring on my premises or as required by a valid warrant.

  • Specialized Government Functions: Military, national security, or correctional institution safety.

  • Workers’ Compensation: To comply with Indiana workers' compensation laws.

V. YOUR OPPORTUNITY TO OBJECT

I may share relevant PHI with a family member or friend involved in your care or payment for care, provided you have been given the opportunity to object and have not done so.

VI. YOUR RIGHTS REGARDING YOUR PHI

  • Right to Request Limits: You may ask me to limit certain uses/disclosures. I am not required to agree unless it affects your safety or is a request to withhold info from a health plan for a service you paid for entirely out-of-pocket.

  • Right to Confidential Communications: You may request that I contact you in a specific way (e.g., home phone only).

  • Right to Access and Copies: You may inspect or receive a copy of your records.

    • Note (Indiana Law): Under IC § 16-39-2, I may deny access if I determine it would be "detrimental to the physical or mental health of the patient," providing a written explanation.

  • Right to Amend: If you believe information is incorrect, you may request an amendment in writing. I may deny this if the record is accurate or was not created by me.

  • Right to an Accounting: You may request a list of disclosures I have made (excluding treatment, payment, and operations) for the last six years.

  • Right to a Paper Copy: You may request a paper copy of this notice at any time.

VII. COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with:

  1. Circle City Alliance Therapy & Consulting at 317-360-5864.

  2. The Secretary of the U.S. Department of Health and Human Services.

You will not be penalized or retaliated against for filing a complaint.