Terms of Service
The Mother Hood Psychotherapy Practice Inc.
Last Updated: [3/12/2025 at 4:50pm PST]
Welcome to The Mother Hood Psychotherapy Practice Inc. By engaging in therapy services with us, you agree to the following Terms of Service. Please read them carefully. If you have any questions, feel free to reach out.
1. Scope of Services
The Mother Hood Psychotherapy Practice Inc. provides psychotherapy and mental health services to clients located in California. Services may be provided in person or via telehealth in compliance with state regulations.
2. Client Eligibility
To receive services, clients must:
• Be at least 18 years old or have parental/guardian consent for minors.
• Be physically located in California at the time of telehealth services.
• Complete necessary intake paperwork, including informed consent forms.
3. Fees, Billing & Payment Policies
• Fees for therapy sessions are determined prior to the start of treatment and will be outlined in a separate Good Faith Estimate if applicable.
• Payments are due at the time of service unless otherwise agreed upon.
• Accepted payment methods include [insert payment methods such as credit card, check, or electronic transfers].
• Late cancellations (less than 24 hours’ notice) or no-shows may be subject to a cancellation fee.
4. No Surprises Act & Good Faith Estimate (GFE)
In accordance with the No Surprises Act, clients who are uninsured or choosing not to use insurance have the right to receive a Good Faith Estimate for the cost of mental health services.
• A Good Faith Estimate will be provided upon request or prior to the start of services.
• The estimate outlines expected costs for services based on your treatment plan.
• If the total billed amount exceeds the estimate by $400 or more, you have the right to dispute the charges.
For more information, visit: www.cms.gov/nosurprises.
5. Confidentiality & Privacy
• Your privacy is important to us. All therapy services are confidential except where disclosure is required by law (e.g., harm to self/others, child/elder abuse).
• Telehealth services are conducted using HIPAA-compliant platforms to ensure confidentiality.
• A full Notice of Privacy Practices is available upon request.
6. Telehealth Services & Telehealth Consent
By engaging in telehealth sessions, you acknowledge and agree to:
• Ensure you are in a private, secure location during sessions.
• Use a stable internet connection to facilitate communication.
• Notify your therapist if technical issues interfere with your session.
Under California law, clients must provide informed consent before engaging in telehealth therapy.
What You Need to Know About Telehealth
• Sessions are conducted via a HIPAA-compliant platform.
• You have the right to ask questions or withdraw consent at any time.
• If technical issues occur, we may reschedule or transition to a phone session.
7. Cancellation & Refund Policy
• Sessions canceled with less than 24 hours’ notice may be subject to a cancellation fee.
• Refunds are not provided for completed sessions.
• If The Mother Hood Psychotherapy Practice Inc. cancels a session, a full refund or rescheduling will be offered.
8. Limitation of Liability
Therapy services are intended for emotional and psychological well-being but do not guarantee specific outcomes. The Mother Hood Psychotherapy Practice Inc. and its clinicians are not responsible for decisions made by clients based on therapy discussions.
* Crisis Disclaimer
🚨 We Do Not Provide Crisis Services 🚨
If you are experiencing an emergency or crisis, please seek immediate support:
• 📞 Call 911 or go to the nearest emergency room.
• 📞 988 Suicide & Crisis Lifeline (Dial 988).
• 💬 Crisis Text Line (Text HOME to 741741).
Therapy at The Mother Hood Psychotherapy Practice Inc. is not a substitute for emergency care.
9. Contact Information
For questions regarding these terms or to request a Good Faith Estimate, contact:
The Mother Hood Psychotherapy Practice Inc.
[Your Email]
[Your Phone Number]
By continuing therapy with The Mother Hood Psychotherapy Practice Inc., you acknowledge that you have read, understood, and agreed to these Terms of Service.