A Collaborative Path Forward
Effective Date: 10.21.2025
At Mapping Resilience Therapy Center LLC (the “Practice”), we are committed to providing the highest quality behavioral health services in an environment that respects your dignity, privacy, and autonomy. This Statement of Patient Rights & Responsibilities outlines what you can expect from us —and what we expect from you — as a partner in your care. This information may be updated periodically. If you have any questions regarding this page, please inform us. You will be required to sign this document through secure platform portal as an agreement between us to initiate care. We can discuss any questions you have when you sign them or at any time in the future. If you need this form in another language or accessible format, please let us know and it will be provided through the Simple Practice client portal
As a patient of the Practice, you have the right to:
You have the right to be treated with respect, dignity, and compassion regardless of race, color, national origin, religion, sex, gender identity or expression, sexual orientation, age, disability, socioeconomic status, or any other legally protected status.
You have the right to receive behavioral health services free from harassment, neglect, or exploitation.
You have the right to receive timely access to appropriate behavioral health care based on your clinical needs.
You have the right to refuse treatment or services and be informed of the consequences of such refusal.
You have the right to have your personal and medical information kept confidential in accordance with the Health Insurance Portability and Accountability Act (HIPAA), applicable state privacy laws, and the ethical standards of behavioral health professionals.
You have the right to request a copy of your medical records and to request amendments or corrections to your health information as permitted by law. To do so, you may submit a written request to the Practice. We will respond to your request in accordance with applicable state and federal regulations, including the timeframes and procedures outlined in HIPAA.
You also have the right to be informed about the limits of confidentiality, including the legal and ethical circumstances under which your provider may be required to share protected information without your consent. Specifically, your provider is mandated by law to break confidentiality in the following situations:
In these situations, disclosures are limited to what is necessary to protect your safety or the safety of others and to comply with legal obligations. Whenever possible, and unless it increases risk of harm, you will be informed if such a disclosure is made.
You have the right to be an active participant in developing, reviewing, and revising your treatment plan.
You have the right to be informed in understandable language about the nature of your condition, recommended treatments, alternatives, risks and benefits, and expected outcomes.
You have the right to involve family members or other people of your choice in your care, if you wish to do so and if clinically appropriate.
You have the right to receive sufficient information to make an informed decision about your care, including the nature and purpose of proposed treatment, risks and benefits, and alternative approaches.
You have the right to withdraw consent or discontinue treatment at any time.
You have the right to be provided with information in a manner that you can understand, including access to language translation or interpretation services if needed.
You have the right to ask questions and receive clear answers regarding your care and services.
You have the right to receive care in a safe and secure environment.
You have the right to be free from physical, emotional, sexual, and financial abuse or exploitation.
You have the right to file a grievance or complaint without fear of retaliation or interference with your care and to receive a timely response. In the event you would like to file a formal grievance or complaint, you should refer to the Practice’s Grievance Policy.
You have the right to receive a clear explanation of fees, billing practices, insurance coverage, and your financial obligations prior to the start of treatment.
You have the right to request an itemized bill and an explanation of charges.
You have the right to receive referrals or continuity of care when your therapist is unavailable, upon discharge, or if you choose to transition care.
You have the right to create and maintain an advance mental health directive, in accordance with applicable state and federal laws. An advance mental health directive is a legal document that allows you to express your preferences for future mental health treatment, including medications, hospitalization, and crisis interventions, in the event that you become unable to make or communicate decisions during a mental health crisis.
The Mapping Resilience Therapy Center LLC will honor valid and applicable advance directives to the extent required by law and consistent with clinical judgment and ethical standards. If you have an existing mental health advance directive, you are encouraged to provide a copy to the Mapping Resilience Therapy Center LLC so that it can be included in your medical record and considered in your care planning.
If you do not have an advance directive and would like information or assistance in creating one, please notify your provider or administrative staff. We will provide you with resources or referrals to help you understand your rights and the options available to you.
You have the right to receive services via telehealth, where appropriate and legally permitted, and to be informed of the risks and benefits of remote care, including potential risks to privacy. The Mapping Resilience Therapy Center LLC uses secure, HIPAA-compliant platforms for telehealth sessions to protect your confidentiality. However, no electronic communication is entirely risk-free, and by choosing to engage in telehealth services, you acknowledge and accept those inherent limitations.
Minor patients (individuals under the age of 18) receiving behavioral health services are entitled to many of the same rights as adult patients, with additional considerations for their developmental needs and legal status. The rights of minor patients include:
Parents or legal guardians also retain specific rights related to the treatment of the minor, including being informed of and consenting to treatment where required, accessing records (subject to applicable laws), and participating in treatment planning. The balance between a minor’s right to privacy and a parent’s right to know will be managed in accordance with federal and state laws, clinical judgment, and best practices for promoting the minor’s well-being.
To support a safe and effective therapeutic relationship, you are expected to:
You are expected to provide accurate and complete information about your health history, symptoms, medications, and relevant life circumstances.
You are expected to notify your provider of any changes to your health, medication regimen, or contact information.
You are expected to collaborate actively in the treatment process, including attending scheduled appointments on time and engaging in agreed-upon interventions.
You are expected to discuss concerns openly with your provider and participate in decision-making.
You are expected to treat staff, providers, and other patients (if in a group setting) with courtesy and respect.
You are expected to avoid aggressive, threatening, or disruptive behavior.
You are expected to respect the privacy and confidentiality of other individuals you may encounter in group therapy or shared spaces.
You are expected to pay co-pays, fees, and balances in a timely manner, and notify the office if you experience financial hardship that may affect your ability to pay.
You are expected to provide accurate insurance information and notify the office of any changes in coverage.
You are expected to arrive on time for appointments and provide at least 48 hours’ notice for cancellations or rescheduling.
You are expected to understand that failure to provide at least 48 hours’ notice of cancellation or rescheduling of appointment will result in full rate for fee.
You are expected to understand that repeated no-shows or late cancellations may result in a termination of care.
You are expected to take prescribed medications as directed and discuss any concerns or side effects with your provider.
You are expected to inform your provider if you are experiencing a crisis or any thoughts of harming yourself or others. If you are experiencing a medical or mental health emergency, please call 911 or go to the nearest emergency room. The Mapping Resilience Therapy Center LLC is not equipped to provide emergency services. You may also contact a local crisis line or the National Suicide & Crisis Lifeline at 988. You are expected to refrain from bringing weapons, drugs, or alcohol onto the premises and during sessions.
You are expected to use the designated communication platforms responsibly and to ensure your own privacy when engaging in telehealth sessions.
If you feel your rights have been violated, you may:
If you think someone is monitoring your devices, visit this website from a computer, tablet, or smartphone that isn’t being monitored.
Exit this website quickly with the ‘Safe Exit’ button in the upper right corner, and then delete it from your browser history.