I acknowledge that all records are kept confidential and will only be accessed by the staff of Holistic Mental Healthcare with my explicit written consent, except in specific circumstances such as court orders, cases of child abuse, life-threatening situations, or national security matters. In some instances, a third party may be responsible for contracting with Holistic Mental Healthcare and have control over access to the information.

Regarding Informed Consent, I agree to participate in necessary psychological assessments, therapy sessions, medication management, recommended medical tests, or follow-up procedures as part of my assessment and treatment plan with the staff of Holistic Mental Healthcare This consent applies to both Tele Video and other electronic interactions as well as in-person sessions. I understand that I have the right to discontinue treatment at any time, except when mandated by court orders. However, discontinuation may have implications, particularly in areas such as employment.

I acknowledge that psychotherapy, medication management, and related practices do not guarantee specific outcomes, and no promises or guarantees have been made to me regarding assessment, consultation, or treatment.

Regarding Research Initiative, Holistic Mental Healthcare may collect information about my symptoms, treatment effectiveness, or other relevant variables. This information, once de-identified, may be used for research purposes to enhance services and contribute to mental health treatment knowledge. I have the option to opt out of this research initiative.

I authorize Holistic Mental Healthcare to leave messages containing relevant health information on my voicemail, answering machine, or with individuals who answer the phone numbers I have provided to them.

By signing below, I confirm that I have received written copies of various documents from Holistic Mental Healthcare, including summaries of federal confidentiality regulations, client rights, grievance policies, client responsibilities, treatment fees, infectious disease policies, and group therapy policies.