You have the right to receive a Good Faith Estimate that explains the expected cost of your mental health services.

Under federal law, health care providers must give a Good Faith Estimate to clients who do not have insurance or who choose not to use insurance. This estimate shows the expected total cost of non-emergency services and may include related items such as assessments, prescriptions, or other associated fees.

You may request a Good Faith Estimate:

• Before scheduling services, or

• At least one (1) business day before your appointment.

If you receive a bill that is $400 or more higher than your Good Faith Estimate, you have the right to dispute the charges.

Please keep a copy of your Good Faith Estimate for your records.

For more information, visit www.cms.gov/nosurprises or call 817-281-6822.

This notice is provided in accordance with Texas House Bill 4224 and Texas Health & Safety Code §181.105.

Access to Mental Health Records

You have the right to request a copy of your mental health records.
Requests must be submitted in writing to your therapist or the practice and may be made via email, secure client portal, or written correspondence. Records are released in accordance with applicable state and federal privacy laws.

If you need assistance requesting your records, please contact our office.

The Texas Behavioral Health Executive Council (BHEC) licenses and regulates mental health professionals in Texas.

Licensure and professional standards information is available at:
https://bhec.texas.gov/contact-us/

If you wish to file a consumer complaint regarding mental health services, you may contact the Texas Office of the Attorney General:

https://www.texasattorneygeneral.gov/consumer-protection