Consumer Policies, Rights, and Information

Please reach out to me with any questions. House Bill 4224 (89th Regular Session),(https://click-1754894.icptrack.com/icp/relay.php?r=115115972&msgid=411039&act=904F&c=1754894&pid=904549&destination=https%3A%2F%2Furldefense.proofpoint.com%2Fv2%2Furl%3Fu%3Dhttps-3A__links-2D1.govdelivery.com_CL0_https-3A-252F-252Fcapitol.texas.gov-252Ftlodocs-252F89R-252Fbilltext-252Fhtml-252FHB04224F.htm_1_0100019b0a602e55-2D779e2a83-2D8e9d-2D4bdb-2Da81e-2D118e28c328d5-2D000000_TqxzjwpRuaMsaQjPR4fkfzrk44SmEC5fYVdsq1sYnvY-3D435%26d%3DDwMFaQ%26c%3DeuGZstcaTDllvimEN8b7jXrwqOf-v5A_CdpgnVfiiMM%26r%3DHqf2PoqjKBcpBIkbFgSyi15ZkrJszq9acwIXAK4Ax_YFKY-Fu99MNlQKyICoOShM%26m%3DlPkb0SqvO05M0pq7lRbSOmCe0pIJOs0gwgPTp6cTuJglV6y_qy0qOdrEeDGfit0I%26s%3DNxVFQ724C1AvG1G85CNcWYYoDJFfrS8dk5wscRyj29o%26e%3D&cf=26771&v=d32e73fdb26e7b06e971316eb37efe0dffc08eff34f8df9aaadb5a0574bae3c9) which went into effect on Sept. 1, 2025, requires licensees to, per Section 181.105 of the Health and Safety Code,(https://click-1754894.icptrack.com/icp/relay.php?r=115115972&msgid=411039&act=904F&c=1754894&pid=904549&destination=https%3A%2F%2Fstatutes.capitol.texas.gov%2FDocs%2FHS%2Fhtm%2FHS.181.htm%23181.105&cf=26771&v=21969acb2c07b1ff8e7f050fae30fa54913b467085e0a289a2c54a727a340d97) prominently post on their website and at any facility detailed instructions for a consumer to: • Request the consumer’s health care records from the licensee; • Contact the Council, as found on the Council's Contact Us webpage;(https://click-1754894.icptrack.com/icp/relay.php?r=115115972&msgid=411039&act=904F&c=1754894&pid=904549&destination=https%3A%2F%2Fbhec.texas.gov%2Fcontact-us%2F&cf=26771&v=940bf72a7ba953d31c154658fe52ee8b030e7357fd9e7541436d826827a70093) and • File a consumer complaint with the Office of Attorney General’s Consumer Protection webpage.(https://click-1754894.icptrack.com/icp/relay.php?r=115115972&msgid=411039&act=904F&c=1754894&pid=904549&destination=https%3A%2F%2Furldefense.proofpoint.com%2Fv2%2Furl%3Fu%3Dhttps-3A__links-2D1.govdelivery.com_CL0_https-3A-252F-252Fwww.texasattorneygeneral.gov-252Fconsumer-2Dprotection_1_0100019b0a602e55-2D779e2a83-2D8e9d-2D4bdb-2Da81e-2D118e28c328d5-2D000000_wuvZQpt2fO3nIjTPxO-5FenIUUmCkepH6uabsi0iGEu3Q-3D435%26d%3DDwMFaQ%26c%3DeuGZstcaTDllvimEN8b7jXrwqOf-v5A_CdpgnVfiiMM%26r%3DHqf2PoqjKBcpBIkbFgSyi15ZkrJszq9acwIXAK4Ax_YFKY-Fu99MNlQKyICoOShM%26m%3DlPkb0SqvO05M0pq7lRbSOmCe0pIJOs0gwgPTp6cTuJglV6y_qy0qOdrEeDGfit0I%26s%3D00WNZZ_rTBEkZyyRUznAkMJs71RSQEKSYDDPiODgt98%26e%3D&cf=26771&v=9571bc228bbd90be6ffb654ecc4230813e659ecad3036a8baf1192cc6bae35cc) Requesting Your Health Care Records • Clients have the right to request access to or copies of their health care records. To request your records, please submit a written request to: Contact Information Willow Creek Counseling, PLLC 200 North Rufe Snow Dr, Ste 118 Keller, TX 76248 📞 682-207-8283(tel:682-207-8283) 📧 willowcreekcounseling.tasha@gmail.com(willowcreekcounseling.tasha@gmail.com) 🌐 www.willowcreekcounselingtx.com(http://www.willowcreekcounselingtx.com) • Requests will be processed in accordance with Texas law. Reasonable fees may apply as permitted by law.

Notice of Privacy Practices & Privacy Policy Willow Creek Counseling, PLLC Effective Date: October 1, 2025 This notice describes how your medical and mental health information may be used and disclosed, how your personal information is protected, and how you can access your information. Please review it carefully. Willow Creek Counseling, PLLC (“we,” “our,” or “us”) is committed to protecting your privacy and maintaining the confidentiality of your Protected Health Information (PHI) in accordance with the Health Insurance Portability and Accountability Act (HIPAA). 1. Our Commitment to Your Privacy We are a HIPAA-compliant provider and safeguard all Protected Health Information (PHI), which includes any information that identifies you and relates to your past, present, or future mental health care or payment for services. We protect your information through: • Secure, encrypted electronic health record (EHR) systems • HIPAA-compliant telehealth, billing, and communication platforms • Limited access to records on a need-to-know basis • Ongoing staff training in privacy and security practices 2. Your Rights Under HIPAA You have the right to: • Access and obtain a copy of your health and billing records • Request corrections to inaccurate or incomplete records • Request confidential communication (e.g., alternate phone, email, or address) • Request restrictions on how we use or share your information • Receive an accounting of disclosures of your information • Receive a copy of this notice • Designate someone to act on your behalf • File a complaint without fear of retaliation 3. How We Use and Disclose Your Information We may use and share your information for the following purposes: Treatment To provide, coordinate, or manage your care. We may share information with other providers involved in your treatment, with your consent except in emergencies. Healthcare Operations To operate our practice, improve quality of care, conduct training, and perform administrative functions. Payment To bill and receive payment for services, including submitting information to insurance providers or billing platforms. 4. Other Uses and Disclosures We may also disclose your information: • As required by law, court order, or legal process • To report suspected abuse, neglect, or exploitation • To prevent or reduce a serious and imminent threat to health or safety • For health oversight activities (e.g., licensing boards, audits) • With your written authorization for uses not otherwise permitted 5. Special Protections for Psychotherapy Notes Psychotherapy notes are maintained separately from your clinical record and receive additional protections under HIPAA. We will not disclose psychotherapy notes without your written authorization, except in limited circumstances, including: • When required by law • To prevent a serious and imminent threat • For internal use related to treatment, training, or quality improvement • For oversight activities such as audits or investigations Psychotherapy notes are never used for marketing or non-healthcare purposes. 6. Personally Identifiable Information (PII) We may collect personal information through forms, scheduling systems, or communication tools, including: • Name, phone number, email, and address • Insurance and payment information This information is used only for care delivery, communication, and administrative purposes. We do not sell or share your information for advertising. 7. Website Use, Cookies, and Analytics Our website may use cookies or analytics tools to understand user activity (e.g., pages visited, device type). These tools: • Do not collect Protected Health Information • Are used only to improve website functionality You may disable cookies through your browser settings. 8. Third-Party Services We use HIPAA-compliant third-party platforms for scheduling, telehealth, billing, and documentation. Our website may include links to external sites (e.g., directories or social media). We are not responsible for: • The privacy practices of those sites • Their content or security 9. Email and Communication Standard email and website contact forms are not considered secure under HIPAA. Please use our secure client portal or approved communication platforms for sensitive or clinical information. 10. Data Security We take reasonable and appropriate measures to protect your information, including: • Encryption and secure storage • Password-protected systems • Limited access controls • Ongoing monitoring and staff confidentiality agreements While no system is completely risk-free, we follow industry standards to minimize risk. 11. Our Responsibilities We are required by law to: • Maintain the privacy and security of your information • Provide you with this notice • Follow the terms of this notice We will notify you if a breach occurs that may have compromised your information. We may update this notice at any time. The updated version will be available upon request and on our website. 12. Your Consent By engaging in services or using our website, you acknowledge and accept the practices described in this notice. You may withdraw consent for optional communications at any time. 13. Contact Information Willow Creek Counseling, PLLC 200 North Rufe Snow Dr, Ste 118 Keller, TX 76248 📞 682-207-8283 📧 willowcreekcounseling.tasha@gmail.com(willowcreekcounseling.tasha@gmail.com) 🌐 www.willowcreekcounselingtx.com(http://www.willowcreekcounselingtx.com) 14. Filing a Complaint If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint. https://www.hhs.gov/ocr/privacy/hipaa/complaints/ (https://www.hhs.gov/ocr/privacy/hipaa/complaints/)

Informed Consent and Service Agreement Willow Creek Counseling, PLLC Before we begin, this document explains how services work here, your rights as a client, and the practical policies that support care, confidentiality, and professionalism. Effective as of the date of client signature. Consent for Services By engaging in services with Willow Creek Counseling, PLLC, you acknowledge that you understand the nature and goals of counseling (therapy) and/or professional consultation, consent to participate in services including telehealth when appropriate, understand the limits of confidentiality, agree not to record sessions, and acknowledge that services provided are not crisis or emergency services. No Guarantees; Risks and Potential Benefits  Counseling and consultation involve active participation. While many clients experience meaningful benefits, specific outcomes cannot be guaranteed. Potential benefits include insight, coping skills, clarity, and growth. Potential risks include temporary emotional discomfort or changes in perspective. Outcomes vary by individual. Confidentiality and Its Limits Information shared during services is confidential except when disclosure is legally or ethically required, including risk of serious harm, suspected abuse or neglect, lawful court orders, reporting of professional misconduct, or Texas law requirements related to human trafficking. Telehealth Services Telehealth services are provided using secure, HIPAA-compliant technology. Misuse may result in suspension or termination of telehealth services. Insurance, Billing, and Financial Responsibility  Willow Creek Counseling, PLLC and its counselors are not providers with any insurance company and do not file insurance claims. We are happy to provide you with a receipt for treatment which contains all the information you will need to submit a claim to insurance. At the end of each month, you will automatically receive an insurance-ready statement called a “Superbill” via email or through the client portal. If you are seeking reimbursement from a healthcare plan privately, you may use this statement to do so. Our office cannot guarantee reimbursement from any insurance plan. Credit Card on File Policy  A valid credit card is required to be kept on file for all clients of Willow Creek Counseling, PLLC, regardless of service type or payment method. The card on file may be charged for payments, late cancellations, no-shows, administrative services, session fees, and any services provided. No-Show and Late Cancellation Policy Appointments are reserved specifically for you. 48 hours’ notice is required to cancel or reschedule without charge. Late cancellations and no-shows incur a full session fee. Additional Consents  Certain services, including Telehealth, require a separate informed consent form. Clients must review and sign the applicable additional consent prior to participation. Arbitration and Dispute Resolution  Disputes shall be resolved through binding arbitration except where prohibited by law. Limitation of Liability  Willow Creek Counseling, PLLC, is not liable for indirect or consequential damages. Clients remain responsible for decisions made outside of sessions. Client Rights, Respect, and Professional Conduct  Clients will be treated with dignity and respect in accordance with professional ethical standards, regardless of race, color, national origin, sex, gender identity or expression, sexual orientation, age, religion, disability, marital status, military or veteran status, or any other protected category under applicable law. Willow Creek Counseling, PLLC, is committed to providing professional services that are respectful, ethical, and aligned with client needs. If a client has concerns regarding the conduct of a provider, those concerns are encouraged to be raised directly when possible. Information regarding the appropriate state licensing board for the provider will be made available upon request. If a client determines that services are not a good fit, Willow Creek Counseling, PLLC will make reasonable efforts to assist with referral to another provider or resource when appropriate. Therapist Information Tasha Devereaux, LPC-S — Texas License #77326. Katie Francis, LCSW-S — Texas License #69509 Tiffany Williams, LPC Associate — Texas License #99259 (Supervised by Tasha Devereaux, LPC-S) Emergencies  Willow Creek Counseling, PLLC is not a crisis service. In emergencies, call 911 or 988.

No Surprise Act & Good Faith Estimate – Client Summary Willow Creek Counseling, PLLC wants to make sure you understand your rights, specifically that you are informed about recent healthcare protections under federal law. What is the No Surprises Act? • The No Surprises Act, effective January 1, 2022, is a federal law designed to protect patients from unexpected medical bills. It ensures you are not surprised by high costs for services you didn’t know were out-of-network or not covered. • At Willow Creek Counseling this applies to clients who: • Do not have insurance • Choose not to use their insurance (self-pay clients) What is a Good Faith Estimate (GFE)?  • If you are uninsured or not using insurance, you have the right to receive a GFE of expected charges before you begin services.   • This estimate includes: • The expected cost of your counseling sessions • Any additional fees (if applicable) • A breakdown of services you may receive • Note: the GFE is not a bill – it’s an estimate based on the information available at the time. Your Rights: • You have the right to receive a written Good Faith Estimate at least one (1) business day before your first session. • You can ask for a GFE at any time during your care. • If your actual charges are $400 or more above the estimate, you can dispute the bill through the Patient-Provider Dispute Resolution Process. • HHS PPDR Individuals Guidance (https://www.cms.gov/cciio/resources/regulations-and-guidance/downloads/good-faith-estimate-patient-provider-dispute-resolution-process-for-uninsured-or-self-pay-individuals.pdf) How Willow Creek Counseling, PLLC Supports This: • We will provide a clear Good Faith Estimate before services begin. • We’re happy to answer any questions you may have about fees, billing, or your rights under this law.

OUR SCOPE OF SERVICES Please note Willow Creek Counseling, PLLC IS NOT A CRISIS SERVICE. If you are in immediate danger, are having a medical or mental health emergency, or need urgent support outside of session hours, please: • Call 911 or go to the nearest emergency room • Contact 24/7 crisis lines such as • 988 Suicide and Crisis Lifeline (call or text 988) • Crisis Text Line: Text HOME to 741741 We are available to support your ongoing care, but we do not provide emergency response or on-call services. Should we at Willow Creek Counseling, PLLC find we are not a good fit for your needs or that you are not a compatible fit with the services available from us, we will work diligently and with respect to find you a provider(s) that better meets your needs. We reserve the right to end services should the needs go beyond their scope, clinical knowledge, ethical limits, or general comfort/safety.

Effective date: 01 October 2025 To protect your privacy and the integrity of the counseling process, recording of sessions by any means (audio, video, or otherwise) is not allowed. This can result in immediate termination of services. If you would like to remember or reflect on session content, you are welcome to: • Take personal notes during or after sessions • Request access to your clinical notes • Ask your counselor to provide a written summary of key points

By accessing and using the website of Willow Creek Counseling, PLLC ("Company", "we", "us", or "our"), you agree to comply with and be bound by the following Terms and Conditions. If you do not agree with these terms, please do not use this website. 1. Use of Website This website is intended for users who are 18 years or older. By using this site, you confirm that you meet this age requirement and are accessing it from a location where we are authorized to provide services. 2. Intellectual Property All content on this website, including but not limited to text, graphics, logos, images, audio, video, and software, is the property of Willow Creek Counseling, PLLC and is protected under copyright and intellectual property laws. You may not use, reproduce, or distribute any content without prior written permission. 3. Privacy We value your privacy. Please refer to our [Privacy Policy] for information on how we collect, use, and protect your personal data. 4. No Guarantees or Warranties Mental health treatment is a collaborative process and results may vary. We do not guarantee specific outcomes from therapy or coaching services. All services are provided "as is" without warranties of any kind, either express or implied. 5. Errors and Omissions While we strive to ensure that all information on our website and in our communications is accurate and up to date, occasional errors or omissions may occur. We reserve the right to correct any errors and to update information at any time without prior notice. We are not liable for any such inaccuracies. 6. No Refunds Policy We understand that investing in your mental health is a significant commitment. Due to the time and preparation involved in delivering therapeutic services, all payments for services rendered or scheduled are non-refundable. If you are unable to attend a session, please refer to our cancellation policy or contact us directly to discuss rescheduling options. 7. Arbitration Agreement By using our services, you agree that any dispute, claim, or controversy arising out of or relating to your use of the website or our services shall be resolved through binding arbitration rather than in court, except for certain claims such as small claims or equitable relief. Arbitration will be conducted by a single, neutral arbitrator in accordance with the rules of the American Arbitration Association (AAA), and will take place in the state where Willow Creek Counseling, PLLC is registered. Each party shall bear its own costs unless the arbitrator determines otherwise. 8. Limitation of Liability In no event shall Willow Creek Counseling, PLLC or its employees, affiliates, or contractors be liable for any indirect, incidental, consequential, or punitive damages arising out of your use of our website or services. Your sole and exclusive remedy is to discontinue using the website or services. 9. Third-Party Links This website may contain links to third-party websites or services. These are provided as a convenience only. We do not endorse, and are not responsible for, the content or practices of any third-party sites. 10. Modifications We reserve the right to update or change these Terms and Conditions at any time. Continued use of the site or our services following any changes constitutes your acceptance of the revised terms. 11. Governing Law These Terms and Conditions are governed by the laws of the state in which Willow Creek Counseling, PLLC is registered, without regard to its conflict of law provisions.Item description