Psychological Counseling, Psychotherapy, Hypnotherapy, Life Coaching, Personal Development. Private Individual & Corporate Training, Seminars, Workshops & Employee Assistance Program (EAP)
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Privacy is a very important concern for all those who come to this organization. It is also complicated because of state laws and our profession. This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.


How We Handle Your Information


This section is important for you to know so you can make the best decisions for yourself and your family. We are also required to tell you about this because of the privacy regulations, the Data Privacy Act of 2012 (RA 10173).


Each time you visit or have consultations with our professionals, information is collected about you and your physical and mental health. It may be information about your past, present or future health or conditions, or the treatment or other services you got from us or from others, or about payment for healthcare.


These information go into your medical or healthcare record on file at our organization:


  • Your history. As a child, in school and at work, and marital and personal history.
  • Reasons you came for treatment. Your problems, complaints, symptoms, needs, goals.
  • Diagnoses. Diagnoses are the medical terms for your problems or symptoms.
  • A treatment plan. These are the treatments and other services which we think will best help you.
  • Progress notes. Each time you come in we write down some things about how you are doing, what we observe about you, and what you tell us.
  • Records we get from others who treated you or evaluated you.
  • Psychological test scores.
  • Information about medications you took or are taking.
  • Legal matters


This list is just to give you an idea; there may be other kinds of information that go into your healthcare record here. We use this information for many purposes. For example, we may use it:


  • To plan your care and treatment.
  • To decide how well our treatments are working for you.
  • When we talk with other healthcare professionals who are also treating you, such as your family doctor or the professional who referred you to us.
  • To improve the way we do our job by measuring the results of our work.


When you understand what is in your record and what it is used for, you can make better decisions about whom, when, and why others should have this information. Although your health record is the physical property of the healthcare practitioner or facility that collected it, the information belongs to you. You can inspect, read, or review it. If you want a copy we can make one for you but may charge you for the costs of copying (and mailing if you want it mailed to you). In some very unusual situations you cannot see all of what is in your records. If you find anything in your records that you think is incorrect, or something important is missing, you can ask us to amend (add information to) your record, although in some rare situations we don’t have to agree to do that.


Privacy and The Laws


State laws require us to keep your information private. We will obey the rules of this notice as long as it is in effect. The organization will abide to the Mental Health Act RA 11036 of 2019 and Data Privacy Act RA 10173 OF 2012. Read full document here:







Professional ethics and the laws of this state prevent us from telling anyone else what we discuss in treatment unless you give us written permission to do so. These rules and laws are the ways our society recognizes and supports the privacy or “confidentiality” of therapy. There are times when the law requires us to reveal certain information. There are limits on our confidentiality. Please refer to “Notice of Privacy Practices”.


1. When the safety and welfare of yourself or another person may be in danger the law requires disclosure. Specifically: you or other persons are in danger, the law requires disclosure.


a. If you are threatening serious harm to another person, we are required to try to protect that person. We are also required to notify the person being threatened.


b. If you seriously threaten or act in a way that is very likely to harm yourself. If you indicate that you have a plan to kill yourself, we may have to seek a hospital for you, or call a family member or other person who can help protect you. If such a situation arises, we will discuss the situation with you before we proceed, unless there is a very strong reason not to. In an emergency where your life or health is in danger, and we cannot get your consent, we may give another professional some information to protect your life. We will try to get your permission first, and will discuss this with you as soon as possible afterwards.


c. If we have reason to suspect, on the basis of our professional judgment, that a child (anyone under 18 years of age) is being or has been abused, we are required to report our suspicions to the authority or government agency vested to conduct child abuse investigations. We are required to make such reports even if we do not see the child in our professional capacity. We are also mandated to report suspected child abuse if anyone tells us that he or she knows of any child who is currently being abused.


  1. There are a few other things you must know about confidentiality and your treatment:


a. We may consult with other professionals about your treatment. This person is also required by professional ethics to keep your information confidential. When your therapist is unavailable, another therapist will be available to assist you. In that instance, pertinent information about your interaction may be shared.


b. We are required to keep records of your treatment. You have a right to review these records.


c. If you are involved in a legal case, a judge has the authority to issue a court order for your treatment records.


  1. Email Communication: The organization will electronically communicate with you through your given email address. Email usage should be used only for arranging or modifying appointments, medical prescription or mental health certificates. If you choose to communicate with our organization via email be aware that all emails are retained in the logs of your and our internet service providers. While it is unlikely that someone will look at these logs, they are, in theory, available to be read by the system administrator(s) of the internet service provider. Any emails your therapist receives from you and any responses sent to you become a part of your legal record. Please do not send information requiring immediate reply over email, as email may not be checked 24/7.


  1. In the event of a psychiatric emergency, we will likely refer you to another institution. By agreeing to this form, you are granting our organization permission to communicate with any other crisis evaluation unit, about your condition and possible recommendations for further treatment.


  1. Finally, here are a few other points:


a. Therapy sessions may seldom be recorded with your permission.


b. We will not share information about treatment with anyone else outside of the organization without a release of records form.


c. Any information that you also share outside of therapy, willingly and publicly, will not be considered protected or confidential.






Welcome! We appreciate your trust and the opportunity to assist you. Please review this information carefully before agreeing at the end. If you have any questions please feel free to discuss them with your treatment provider.


Benefits and Outcomes of Mental Health Treatment


In addition to the gains and positive outcomes that are associated with counseling, sometimes there are also unanticipated effects. Because counseling, whether it be individual or group therapy, involves discussing issues that have or are presenting you with some difficulty, you may find:


1) that you are devoting more energy to focusing on your issue(s);

2) emotions that you had not experience before may be more available to you;

3) you may see things in new or different ways which may be confusing; and

4) relationships may be affected as you examine interpersonal issues.


These changes, albeit sometimes stressful in the beginning, can ultimately contribute to better self-understanding and more meaningful experiences. To best meet the needs of as many clients as possible, the organization utilizes a short-term treatment model and offers a range of treatments, including group, workshop, and/or individual treatment. Clinicians will assess clients’ needs and use clinical judgment to determine the most appropriate treatment modality and length of treatment. Clients who are determined to need longer-term services and/or would be best served by an outside provider will be referred to other sources of assistance. It is important to arrive on time for your scheduled appointment.


Psychiatrists and Medications


If deemed appropriate, you may be referred for a psychiatric evaluation with a psychiatrist. Medications can be helpful for certain mental health conditions when they are affecting your ability to function and/or care for yourself. If the psychiatrist recommends medications, the psychiatrist will review with you how the medication may benefit you, how it works, side effects of the medication and if any bloodwork is needed to monitor for side effects, alternatives to the recommended medication (including no medications) and expected outcomes of the alternatives, the medication’s dose and frequency, drug interactions (if applicable), and any special instructions for taking the medication. You can then decide whether or not you would like to take the recommended medication in addition to therapy or continue with just therapy. If you do choose to take medications, it is important to take them exactly as prescribed.


Missed or Late Cancellation Appointment Policy


At least 15 hours notice will be required to cancel or reschedule an appointment without being fully charged. This is to give other clients the opportunity to set a schedule with their therapist and also to respect the professional’s reserved time. DFS gives a maximum 15-minute grace period for waiting time. Reminders via our booking software are being automatically sent to your email address 24 hours and 1 hour before your scheduled appointment. If you still fail to attend your scheduled appointment without notification or do not cancel at least 15 hours in advance, it is considered a missed session and shall be billed at full rate. Again, please also respect the time of the Professional waiting for you. Clients who have missed three sessions in a rolling three-month period will lose eligibility for counseling services and will not be rescheduled for another appointment for the remainder of the term, or if it occurs at the end of the quarter, will not be scheduled during the next term. In this case, the organization can assist the client in finding a referral in the community.


This document is presented before the client submits their information and during appointment reminders. With this, the client has read and understood to abide by the points stated above. The client fully agreed to comply with the conditions outlined in the document.