Effective Date: July 1, 2026

Thank you for choosing Riverwood Psychotherapy LLC. These policies (Items No. 1 — 28 below) help create a predictable, respectful therapeutic relationship while ensuring compliance with applicable Oregon, Colorado, and federal laws.

1) Core Terminology

Provider refers to the licensed clinician or supervised associate/intern authorized to provide mental health services.

Client refers to the individual, couple, or family receiving services. For minors, the client is the child, although certain legal rights belong to the parent or legal guardian depending on state law.

Practice refers to Riverwood Psychotherapy LLC, including its clinicians, administrative staff, and business operations.

Treatment includes psychological assessment, diagnosis, psychotherapy, consultation, and related behavioral health services.

2) Attendance & Cancellation Policy

Your appointment time is reserved exclusively for you. Consistent attendance supports effective treatment and allows appointments to remain available for all clients.

24-Hour Cancellation Policy

Appointments canceled with less than 24 hours' notice, or missed without notice ("no-shows"), are subject to a $100 late cancellation fee.

Insurance companies do not reimburse missed appointment fees. These fees are the client's responsibility.

3) Card on File

By receiving services through Riverwood Psychotherapy LLC, you authorize the Practice to securely maintain a payment method on file and charge agreed-upon fees, including:

• Session fees

• Copays, deductibles, and coinsurance

• Late cancellation or no-show fees

• Other non-covered professional services described below

4) One Courtesy Waiver

Each individual client — or couples/family case — receives one (1) courtesy waiver per calendar year for a documented emergency or sudden illness.

This courtesy waiver does not apply to Intake Appointments.

5) Telehealth Option

If illness or transportation issues prevent you from attending in person, your appointment may be converted to a secure telehealth session when clinically appropriate.

6) Therapist Cancellations

If your provider must cancel due to illness, emergency, or unforeseen circumstances, there is never a cancellation fee. We will make every reasonable effort to reschedule you promptly.

7) Late Arrival

Appointments end at their scheduled time regardless of arrival time. Clients arriving more than 15 minutes late may be charged a missed appointment fee and need to reschedule if insufficient time remains to provide clinically appropriate care.

8) Telehealth Policies

Telehealth services are available to eligible clients receiving care in Oregon or Colorado.

9) Location Requirements

At the beginning of every telehealth session, you will be asked to verify your physical location.

You must be physically located in a state where your Provider is legally authorized to practice at the time services are delivered. If you are located elsewhere, your appointment may need to be canceled or rescheduled. Please notify your provider at least 24 hours in advance of your appointment if you unable to be located in the state where services are provided.

10) Safe Environment

For everyone's safety, telehealth sessions cannot occur while:

• Driving

• Operating machinery

• In public spaces where privacy cannot reasonably be maintained

• At home when other family or household members are present in the same room, unless they are actively enrolled in services (e.g. couples or family therapy)

• Under the influence of alcohol or non-prescribed substances that impair participation

If these conditions cannot be met, the session may be ended and all applicable fees may apply.

11) Technology

Technology occasionally fails.

If a video connection is interrupted, your Provider will attempt to reconnect and may continue by telephone when clinically appropriate.

If technical difficulties prevent meaningful clinical services from being provided, your Provider will determine whether the appointment should be rescheduled, completed by phone (when appropriate), or billed based on the clinical services actually delivered.

Clients are responsible for maintaining access to a reliable internet connection and compatible technology.

12) Privacy & Confidentiality

Your health information is protected under the Health Insurance Portability and Accountability Act (HIPAA) and applicable Oregon and Colorado confidentiality laws.

Limits of Confidentiality

Confidentiality may be legally or ethically limited in situations including:

• Suspected abuse or neglect of a child, older adult, or vulnerable adult

• Serious and imminent risk of harm to yourself

• Serious and imminent risk of harm to another person

• Court orders or other legal requirements

• Licensing board investigations or other circumstances required by law

13) Internal Access

Members of the Practice may access protected health information only as necessary for treatment, payment, healthcare operations, quality assurance, or other legally permitted purposes.

14) Access to Records

You have the right to inspect or receive a copy of your records, generally within 30 days of a written request.

Reasonable, cost-based fees permitted under applicable federal and state law may apply for copies, summaries, postage, or expedited processing.

15) Financial Responsibility

Clients are ultimately responsible for all charges incurred, regardless of insurance coverage.

16) Insurance

Submitting claims to insurance is provided as a courtesy.

Verification of benefits or prior authorization is not a guarantee of payment.

Clients are responsible for:

• Knowing their benefits

• Deductibles

• Copays

• Coinsurance

• Informing the Practice of insurance changes before appointments

• Any balances not paid by insurance

17) Self-Pay Clients

Clients who are uninsured or who choose not to use insurance have the right to receive a Good Faith Estimate under the federal No Surprises Act.

Our current fee schedule is as follows: Individual Therapy Sessions (50-55 minutes) $150; Couples or Family Sessions (50-55 minutes): $180.

18) Professional Services Outside Therapy

Services outside scheduled psychotherapy—including report writing, court preparation, consultation with third parties, extended phone calls, travel, or documentation which require more than 10 minutes to complete—are billed at $33 per 10-minute increment unless otherwise agreed.

These services are generally not covered by insurance.

19) Outstanding Balances

Payment is due at the time of service.

If a balance remains unpaid for two consecutive appointments or more than 15 days, non-emergency services may be temporarily paused until payment or a written payment arrangement is established.

If a balance remains unresolved after 30 days despite reasonable communication attempts, the Practice may begin a formal termination process while providing appropriate referrals and ensuring continuity of care consistent with ethical and legal obligations.

20) Ending Treatment

Therapy is voluntary.

Clients may discontinue treatment at any time.

Because Riverwood Psychotherapy LLC currently provides telehealth-only services for Colorado clients, withdrawal of consent for telehealth may require referral to an outside provider.

The Practice may recommend discharge or transfer of care when:

• Treatment goals have been achieved

• Services are no longer clinically appropriate

• A higher level of care is indicated

• Attendance policies are repeatedly violated

• The therapeutic relationship is no longer effective

• Financial obligations remain unresolved after reasonable efforts

Whenever clinically appropriate, referrals will be provided to support continuity of care.

21) Attendance Review

Consistent attendance is an important part of effective psychotherapy. Repeated attendance concerns may result in a review of whether services remain clinically appropriate and may lead to changes in scheduling or administrative discharge.

Examples include:

• Two (2) consecutive missed appointments: Your Provider will review whether the current treatment arrangement remains appropriate. Recurring appointments may be discontinued, and future appointments may be scheduled on a week-to-week basis.

• Three (3) consecutive missed appointments: The Practice may administratively close your file after making reasonable efforts to contact you, unless there is a documented clinical reason to maintain services.

• Three (3) or more late cancellations within a three-month period: Your Provider may review whether the current treatment plan and scheduling arrangement continue to meet your needs. Changes to scheduling frequency or treatment recommendations may be discussed.

• Failure to respond to Practice communications for thirty (30) days: If we are unable to reach you despite reasonable outreach efforts, your case may be considered inactive and your file may be administratively closed.

Whenever clinically appropriate, Riverwood Psychotherapy LLC will make reasonable efforts to contact you before administrative discharge and, when appropriate, provide referrals or recommendations to support continuity of care.

22) “No Tolerance” Policy

Riverwood Psychotherapy LLC is committed to maintaining a safe environment for clients and staff.

Threatening, abusive, discriminatory, intimidating, or violent behavior toward staff or providers may result in immediate suspension or termination of services, consistent with applicable ethical and legal obligations.

When appropriate, referrals to alternative providers will be offered.

23) Minor Consent

Minor consent and confidentiality rights differ between Oregon and Colorado.

Services provided to minors will follow the laws of the state in which treatment occurs, including applicable consent requirements, confidentiality protections, and parental access provisions.

Providers will encourage appropriate family involvement whenever clinically beneficial while protecting the minor's legal rights and safety.

24) Emergencies

Riverwood Psychotherapy LLC is not a 24-hour crisis service.

If you are experiencing a medical or psychiatric emergency:

• Call 911

• Go to your nearest emergency department

• Call or text 988, the Suicide & Crisis Lifeline

Email, voicemail, and text messaging should never be used for emergencies.

25) Electronic Communication

While Riverwood Psychotherapy LLC uses HIPAA-compliant technology whenever possible, no electronic communication method is completely secure.

Please use email and text messaging only for:

• Scheduling

• Billing questions

• Administrative matters

Clinical concerns should be discussed during your therapy session rather than through email or text.

26) Scope of Services

Riverwood Psychotherapy LLC provides outpatient behavioral health treatment.

Some individuals may require services beyond the Practice's scope or a higher level of care.

Referral to specialized providers or programs may be recommended for conditions including, but not limited to:

• Active interpersonal violence

• High-risk substance use disorders

• Severe eating disorders requiring medical monitoring

• Acute psychiatric instability

• Conditions requiring intensive outpatient, residential, or inpatient treatment

Appropriate referrals will be provided whenever possible.

27) Care Coordination

With your written authorization when required, Riverwood Psychotherapy LLC may coordinate care with:

• Primary care providers

• Psychiatric medication providers

• Other healthcare professionals involved in your treatment

If in-person treatment is clinically indicated and cannot be provided by this Practice, referrals to appropriate community providers will be made as promptly as possible.

28) Record Retention

Clinical records are retained in accordance with applicable Oregon and Colorado law, HIPAA requirements, professional standards, and payer requirements.

After the required retention period has expired, records are securely destroyed using industry-standard methods designed to protect your confidentiality.