TABLE OF CONTENTS
- Introduction
- Notice of Privacy Practices (HIPAA Summary)
- 42 CFR Part 2 (SUD Clients Only)
- Universal Telehealth Informed Consent
- Session Transcription Consent
- Psychotherapy Informed Consent
- Client Rights & Responsibilities
- Confidentiality & Limits of Confidentiality
- Emergency & Crisis Protocol
- Financial Policies + Cancellation Policy
- Electronic Communication Consent
- Section 1557 Nondiscrimination Notice
- Accessibility Statement (ADA/504/1557)
- State-Specific Disclosure Addenda
A. Colorado
B. Oregon
C. Washington
D. Arizona
E. North Carolina
- Consent & Signature Page
1. INTRODUCTION
Welcome to ReachLink. We provide nationwide telehealth behavioral-health services delivered by independently licensed clinicians including LCSWs, LMHCs, LPCs, and LMFTs.
This packet contains important information regarding your rights, responsibilities, confidentiality, and how telehealth treatment works.
You must review all sections and complete the signature page.
Company Address:
3651 FAU Blvd, Ste 400, Boca Raton, FL 33431
Phone: 833-588-7992
2. NOTICE OF PRIVACY PRACTICES (HIPAA SUMMARY)
ReachLink complies with HIPAA. Your rights include:
- Right to access and receive copies of your health information
- Right to request amendments
- Right to request limits on disclosures
- Right to confidential communication
- Right to a copy of ReachLink’s full Notice of Privacy Practices (NPP)
Full NPP available at:
3. 42 CFR PART 2 NOTICE (SUD ONLY)
If you receive any substance-use-related treatment or screening through ReachLink, your records may be protected by 42 CFR Part 2, which prohibits disclosure of SUD information without your written consent, except in:
- Medical emergencies
- Court orders meeting strict criteria
- Qualified audits or evaluations
- Internal communication within the program
Redisclosure is prohibited without your explicit permission.
4. UNIVERSAL TELEHEALTH INFORMED CONSENT
By signing this packet, you consent to the use of telehealth technologies (video, audio, and digital communication).
You understand:
- Telehealth involves electronic transmission of your health information.
- There are risks including technological failures and privacy vulnerabilities.
- Benefits include convenience and increased access.
- You must provide your physical location at the start of each session.
- Sessions may be switched to phone or rescheduled if technical issues arise.
- Telehealth is not suitable for emergencies.
You may withdraw telehealth consent at any time.
5. SESSION TRANSCRIPTION CONSENT
ReachLink does not create or store audio or video recordings of your therapy sessions.
By signing this packet, you consent to the transcription of your therapy sessions. Transcription means that spoken conversation during a session may be converted into written text as the session takes place.
You understand and agree that:
- Session transcripts may be created as part of your treatment and clinical record.
- Transcripts may include what was said during the session, timing information, and an indication of who was speaking.
- Transcripts may be used to support clinical documentation, treatment, clinical supervision, quality review, and healthcare operations.
- Transcription may be performed or supported by ReachLink’s telehealth platform and other service providers that are required to safeguard your information.
- Transcription is performed by our telehealth platform provider. The resulting transcript may then be processed by artificial intelligence providers to assist your clinician in preparing clinical documentation. Each of these providers operates under a Business Associate Agreement with ReachLink and is prohibited from using your information to train their models.
- Transcripts are protected as health information and handled according to ReachLink’s Privacy Policy and Notice of Privacy Practices.
A condition of receiving services. Transcription forms part of how ReachLink documents and delivers care. Consent to transcription is required in order to receive services through ReachLink. If you do not wish your sessions to be transcribed, we are not able to provide services to you through this platform, and we will help you understand other options for care.
By signing this packet, you acknowledge that you have read and understand this Session Transcription Consent and consent to the transcription of your therapy sessions as described.
6. INFORMED CONSENT FOR PSYCHOTHERAPY
Psychotherapy may include discussing sensitive topics and may lead to temporary emotional discomfort.
Potential benefits include:
- Increased insight
- Improved coping skills
- Reduction of symptoms
- Better emotional functioning
You may stop treatment at any time except when restricted by court order or safety concerns.
7. CLIENT RIGHTS & RESPONSIBILITIES
You have the right to:
- Respectful and nondiscriminatory treatment
- Participate in your treatment plan
- Ask questions and be informed
- Request a change of clinician
- Confidentiality within legal limits
- Access your records
You are responsible for:
- Being truthful and providing accurate information
- Attending scheduled appointments
- Communicating concerns or crises to your clinician
- Following your safety plan if applicable
8. CONFIDENTIALITY & LIMITS OF CONFIDENTIALITY
Your clinician will keep your information private except when disclosure is required by law, including:
- Suspected child abuse, adult abuse, or elder abuse
- Imminent risk of harm to self or others
- Court orders
- Certain public health reporting
- Tarasoff-type duty to warn (specific rules vary by state)
- 42 CFR Part 2 requirements for SUD (if applicable)
Your clinician will explain any questions about confidentiality.
9. EMERGENCY & CRISIS PROTOCOL
Telehealth cannot safely manage emergencies.
If at any time you experience:
- Suicidal intention
- Homicidal intention
- Severe medical symptoms
- Threat to safety
Call 988, 911, or go to the nearest hospital.
Your clinician may create a Safety Plan with you.
10. FINANCIAL POLICIES & CANCELLATION POLICY
You agree to pay all fees and charges for services, including copayments and deductibles.
Cancellation Policy:
- For commercial (insurance and self-pay) sessions, a $30 missed-appointment fee applies to any session missed by the client — a cancellation or reschedule within 24 hours of the appointment (including same day), or a no-show.
- EAP clients are not charged a fee; instead, each such event results in an immediate account suspension and requires re-attestation to the cancellation policy before scheduling resumes.
- Fee waivers are limited to exceptional circumstances, are not guaranteed, and require supporting documentation submitted through ReachLink's appeal process.
- Repeated missed appointments may result in termination of services at ReachLink's discretion, including on a first occurrence.
- See the full Cancellation, Rescheduling & Missed Appointment Policy for complete details.
This policy applies only to cancellations, reschedules, or no-shows initiated the client. If your provider needs to cancel or reschedule a session, different terms apply and no fee will be charged to you.
Payment must be kept current to continue services.
11. ELECTRONIC COMMUNICATION CONSENT
You consent to communications via:
- SMS/text
- Secure messaging
- Telehealth platforms
You understand that email and text may have security risks.
You may opt out of marketing messages at any time.
12. SECTION 1557 NONDISCRIMINATION NOTICE
ReachLink does not discriminate on the basis of:
- Race
- Color
- National origin
- Age
- Disability
- Sex
- Gender identity
- Sexual orientation
Language and disability accommodations are provided free of charge.
Full 1557 notice + 15-language taglines provided on our website.
13. ACCESSIBILITY STATEMENT (ADA/504/1557)
ReachLink strives to maintain digital accessibility consistent with WCAG 2.1 AA and provides reasonable accommodations free of charge, including:
- ASL interpreters
- Captioning services
- Alternative formats
- Assistance using telehealth platforms
Accessibility requests:
📞 833-732-2489
14. STATE-SPECIFIC DISCLOSURE ADDENDA
(Applied automatically according to client’s state.)
14A. Colorado – Mental Health Practice Act Disclosure (C.R.S. 12-245)
Colorado requires disclosure of:
- Your clinician’s credentials:
LCSW, LMHC, LPC, LMFT (depending on your assigned clinician)
- Your right to:
- competent service
- request records
- receive information about methods
- confidentiality limits
- Board contact:
Colorado Department of Regulatory Agencies (DORA) – Mental Health Boards
Phone: (303) 894-7800
Colorado law prohibits sexual intimacy between a therapist and client for at least 2 years after termination.
14B. Oregon – Professional Disclosure Statement
Required by ORS 675.
Includes:
- Clinician name, degree, and license
- Approach to counseling
- Fees and billing
- Record-keeping practices
- Client rights under Oregon law
- Complaint contact:
Oregon Board of Licensed Professional Counselors and Therapists
Phone: (503) 378-5499
14C. Washington – Mandatory Disclosure Statement (WAC 246-809/810)
Includes:
- Provider credentials: LCSW, LMHC, LPC, LMFT
- Counseling philosophy and methods
- Expected course of treatment
- Fee schedule
- Emergency contact protocols
- Complaint contact:
Washington Dept. of Health – Health Systems Quality Assurance
Phone: (360) 236-4700
14D. Arizona – Behavioral Health Client Disclosure
Includes:
- Provider credentials
- Telehealth informed consent required by A.R.S. §36-3602
- Record retention policy
- Risks and benefits of therapy
- Complaint contact:
Arizona Board of Behavioral Health Examiners
Phone: (602) 542-1882
14E. North Carolina – Counseling & Social Work Disclosure
Includes:
- Provider credentials: LCSW, LMFT, LCMHC-equivalent
- Supervision disclosure (if applicable)
- Fees and billing
- Confidentiality limits
- Complaint contacts:
NC Social Work Certification & Licensure Board – (336) 625-1679
NC Board of Licensed Clinical Mental Health Counselors – (844) 622-3572
15. CONSENT & SIGNATURE PAGE
By signing below, you acknowledge and agree that:
- You have read and understand the entire ReachLink Intake Packet.
- You consent to telehealth treatment.
- You consent to the transcription of your therapy sessions as described in this packet.
- You understand the risks, benefits, and limits of confidentiality.
- You have received the HIPAA Notice of Privacy Practices.
- If applicable, you have received the 42 CFR Part 2 notice.
- You understand financial policies and cancellation fees.
- You agree to the use of electronic communication.
- You understand your state-specific disclosure (if applicable).
- You consent to treatment through ReachLink and its affiliated clinicians.
Client Name: _
Signature (Electronic/Written):
Date: __
Clinician Name: _
Clinician License Type: LCSW / LMHC / LPC / LMFT