Consent Disclosure – The BrainBridge

Introduction

Welcome to The Brain Bridge, PLLC. We are committed to providing high-quality, compassionate psychotherapy and related mental health services in a confidential and supportive environment. This document outlines important information about our professional services, limits of confidentiality, client rights, and privacy practices in compliance with HIPAA (Health Insurance Portability and Accountability Act).

By engaging in services with The Brain Bridge, PLLC, you acknowledge that you have read, understood, and agree to the following terms and disclosures.

Services Provided

The Brain Bridge, PLLC offers psychotherapy, counseling, clinical assessments, and telehealth services for adults, adolescents, and children. Services may include:

Individual, family, and group therapy
Trauma-informed care and evidence-based treatment
Psychological and emotional support
Virtual (telehealth) therapy sessions conducted via secure, HIPAA-compliant platforms

All clinical services are provided by licensed clinicians in accordance with professional and ethical standards.

Informed Consent for Treatment

Participation in therapy is voluntary. Clients (or legal guardians for minors) have the right to:

Ask questions about any aspect of treatment
Withdraw consent for treatment at any time
Request a referral or discontinue services

Therapy may include discussing difficult experiences, which may bring up uncomfortable emotions. This is a normal part of the healing process. Your clinician will support you through this process and collaborate on your goals for care.

Confidentiality and Its Limits

Your privacy is protected under HIPAA and state law. All information shared in therapy is confidential except in the following situations required or permitted by law:

If there is reason to believe you may harm yourself or someone else
If there is suspected abuse or neglect of a child, elder, or vulnerable adult
If records are subpoenaed by a court or required for legal proceedings
If disclosure is necessary for professional consultation or supervision (with identifying information limited)

Your clinician will discuss any potential disclosure whenever possible and appropriate.

Minors and Parental Involvement

Clients under the age of 18 require parental or guardian consent to receive services. While parents have legal rights to access certain information, confidentiality between a minor and therapist is also protected to encourage openness. The therapist will discuss limits of confidentiality with both the child and parent at the outset of treatment.

Professional Boundaries and Ethics

All clinicians at The Brain Bridge, PLLC are licensed and bound by the Code of Ethics of their respective professional boards. Dual relationships (e.g., friendships, social media contact, business relationships) that could impair objectivity or confidentiality are not permitted.

Fees, Cancellations, and Insurance

Payment and billing policies are discussed prior to treatment. If you are using insurance, your information may be shared with your insurer for payment and authorization purposes.

Please provide at least 24 hours’ notice for cancellations or rescheduling to avoid late fees.

HIPAA Privacy Policy

Under the Health Insurance Portability and Accountability Act (HIPAA), you have the right to:

Receive a copy of your health information
Request corrections to your record
Limit certain disclosures
Receive a list of disclosures made about you
File a complaint if you believe your privacy rights have been violated

Your information will only be used or disclosed for treatment, payment, and healthcare operations, or as otherwise permitted by law. We take all reasonable measures—technical, administrative, and physical—to safeguard your personal data.

Electronic Communication and Records

Electronic communication (email, text, portal messages) is not a secure form of communication and should be used for administrative purposes only (e.g., scheduling). Clinical matters should be discussed in session whenever possible.

Records are maintained electronically in secure, HIPAA-compliant systems and retained according to state and federal regulations.

Emergencies

If you are experiencing a life-threatening emergency, do not wait for your therapist to respond.

Call 911 or go to your nearest emergency department.

For mental health crises, you may contact the National Suicide and Crisis Lifeline at 988 (available 24/7).

Notice of Privacy Practices and Updates

This Privacy Policy may be updated periodically to comply with changes in law or practice operations. The most current version will always be available at The Brain Bridge, PLLC office or on our website.

Acknowledgment

By continuing to use this website and/or receiving s