Company Name / Client Reference Hereafter
New Directions Substance and Behavioral Services is hereafter referred to as "NDSBS". NDSBS is a division of Directions Counseling Group, Incorporated, a mental health corporation established in the state of Ohio. The term "NDSBS" refers to the corporate entity, Directions Counseling Group, Inc. as well as its website (ndsbs.com), directors, officers, agents, employees, successors and assigns. Hereafter, registered users of the NDSBS.com website shall be referred to as "you/your", "client" or "the client".
Adults/Minors Requesting Service
Solo Participation & False Identity
You agree to answer questions and questionnaires without the presence or assistance of any third party and agree not to have any third party present at an in-person, telephone or video/webcam interview without first making a direct request to NDSBS and stating the reason that you wish for a third party to be present. NDSBS has the right to deny any such requests if they deem them inappropriate for any reason. You explicitly agree to not have another party stand in as your representative or falsely present themselves in an interview using your identity.
Online Service Limitations
NDSBS provides in-person as well as online services. You understand that use of online services may not be an appropriate form of care for persons in an emotional or mental health crisis. We reserve the right to assess your situation and decline to offer you services if we believe it is not in your best interests to do so. If we are working with you and a mental health crisis develops we will refer you to your local emergency services and mental health providers where you can be seen in-person. Any fees paid to NDSBS prior to a mental health crisis will qualify for consideration of a partial or full refund, at the discretion of the NDSBS Director, and depending on the amount of services rendered before a referral to a local agency is made.
Consent for Treatment
You understand and consent to treatment for professional services from NDSBS. NDSBS services are provided by certified and/or licensed mental health practitioners and as such may render a mental health diagnosis where appropriate and indicate such diagnoses in your written records. You also consent to the release of information for therapeutic, billing, supervision and other purposes in connection with your treatment, between and among NDSBS therapists, staff and service contractors who perform supervisory work on behalf of NDSBS. You understand that for a more detailed description of how your (or your child’s) health information may be released and used is contained in the current Notice of Privacy Practices. This is available in brochure form in the physical office of New Directions Substance and Behavioral Services as well as on the ndsbs.com website.
General Information Security Practices
NDSBS recognizes the absolute importance of keeping client records private and confidential. This section of the Agreement includes our general security practices to keep your information private:
- all records are stored on SSL encrypted servers
- paper records/documents related to your service are kept in locked cabinets
- account passwords are set to health industry standards to include appropriate length and sufficient variation in characters to minimize chances of access by any third party
- sessions conducted via webcam/video are not recorded by NDSBS
- NDSBS does not sell your email or other personal contact information to any parties
- Occasionally for training and supervision purposes we may request that you allow an audio recording of your clinical interview. You are free to decline such requests and any recordings agreed to will be destroyed within 30 days of the recording
Limits to Confidentiality and Privacy
Privacy and confidentiality are not only important to have a trusted exchange of client/ clinician information, but they are also items subject to federal law. NDSBS complies with federal confidentiality guidelines under Federal Confidentiality regulations (42 CFR Part 2) and the Health Insurance Portability and Accountability Act (HIPAA 45 CFR). This protection of confidentiality also specifically (42/Part 2) protects the records of mental health, alcohol and drug abuse patients, including the prohibition of re-disclosure of information from client/patient records. HIPAA also requires that mental health and substance abuse professionals provide notice to all clients that information provided by NDSBS and voluntarily disclosed to third parties by you (to courts, probation officers, physicians, schools, etc.) may be re-disclosed by these third parties.
Furthermore, in compliance with the aforementioned federal laws, NDSBS has the obligation to limit confidentiality and report specific information in the following circumstances:
- NDSBS is mandated to report suspected or known abuse of children and vulnerable adults to local law enforcement and/or local child/adult protective agencies.
- NDSBS is mandated to report specific information to local law enforcement in situations where a client is at significant risk for taking their own life or the life (or lives) of another (others). NDSBS will make a concerted effort to assist clients in accessing appropriate professional care in such circumstances.
- NDSBS is obligated to release your records for legal proceedings if ordered by a court to do so.
NDSBS uses security encrypted (SSL) transmission for all professional assessment and counseling services completed online. If you choose a webcam/video/telephone service, including uploading, downloading, or faxing personal information to or from NDSBS, you should be aware that risk of interception of your information, though unlikely, is a possibility. NDSBS client records are stored on encrypted secure servers or in secure facilities where access is limited to the professional evaluator assigned to the client and their clinical supervisors. Identifying names are not used by the evaluator if discussing client circumstances with a professional supervisor.
There is also no express or implied warranty for any client losses, damage or harm occurring from the use of electronic services, which would include: unauthorized data interception or data/records theft by a third party, unintended utility charges by a third party, computer/electronic viruses, accidental deletion of data or records, or any other claim of harm arising from your choice to engage NDSBS services using electronic means (telephone, fax, internet, wireless, email, video/webcam or any other electronic delivery services that might be used in the future).
Responsibility for Transfer of Your Records to Requesting Parties
You understand that NDSBS will place an official document signed by a credentialed professional in your online account with NDSBS. You understand and agree that you are responsible to provide the official document directly to any requesting parties (e.g. court, probation officer, attorney, employer, etc.) You are strongly encouraged to review the document in its entirety before forwarding it to any requesting parties. You should notify NDSBS immediately if you feel there is inaccurate or erroneous information in your report. Your report will not be directly forwarded to any third parties by NDSBS without your express written request and permission to do so.
Financial Responsibility & Fees
You understand that payment for service is due before receiving services from NDSBS. Additionally, you understand that NDSBS has no contractual obligation with your insurance company or you that would guarantee you reimbursement for expenses you incur for any and all services from NDSBS.
You also understand that fees for services are posted on our website except in certain cases where fees are dependent on time demands of your case (e.g. in depth assessments for the FAA, ILC evaluations, some license reinstatement assessments, or other services which are determined and mutually agreed upon at the time of the service request).
Client Cancellation Policy and Broken Appointment Fees
You understand and agree that a fee may be charged to your account if you cancel your interview or appointment with less than 24 hours notice. You also understand and agree that NDSBS reserves the right to cancel your service and refund your payments minus any broken appointment fees if you cancel 2 or more scheduled interview or appointment times with less than 24 hours notice. Broken appointment fees are $65.00 per appointment and are charged to partially offset the loss of revenue which occurs when a time has been reserved for a client but which can no longer be booked due to the short notice in cancellation.
Client Will Accurately Report Information
As a client, you agree to provide accurate information about yourself and the circumstances surrounding your need for an evaluation or counseling to the best of your ability. This includes an agreement to not omit information relevant to your situation or present inaccurate information. If inaccurate information is provided or important information is purposely omitted, you will not be eligible for a refund if your assessment is not accepted.
NDSBS is not a Government Entity
You understand that NDSBS is not a state or federal organization. While our assessments and clinical reports are generally accepted by other professionals and government agencies you also understand that any clinical conclusions, diagnoses or professional recommendations provided by NDSBS may or may not be accepted or approved by courts, state or federal agencies. Furthermore, courts, state and federal agencies are not bound to agree with our assessments or clinical recommendations.
Refund Terms & Limitations
You understand and agree with our conditions and limits to grant a refund. Refunds are only given in circumstances where the requesting party (court, physician, probation department, etc.) will not accept the assessment we provided and the following procedures are followed:
- All refund requests must be initiated through your ndsbs.com account by clicking on “my transactions” and “refund requests” in your account dashboard
- All refund requests must be applied for within 45 days of your original registration.
- NDSBS will first attempt to contact any third party that does not accept your assessment to see if there is some additional information needed in order to gain acceptance of your report or service. In this circumstance you will need to first sign and return (fax or scan/email) a release of information form to allow your evaluator to speak with the third party.
- If we cannot make contact with the requesting party, you must provide written proof that your evaluation was not accepted by the requesting party. The document stating your assessment was not accepted must be on the letterhead of the requesting party and have an address, phone number and contact name included on it.
- Refunds are not granted in situations where the client being evaluated:
- omitted key information or;
- provided inaccurate information or;
- missed an assessment completion deadline because: a) NDSBS was not informed of the due date, b) client did not meet with the evaluator at the originally scheduled time, c) client did not provide NDSBS with necessary documents requested by your evaluator or by the third party requesting the assessment
- all assessments used in context of child custody proceedings are non-refundable (due to the contentious nature of child custody proceedings)
- If a portion of your fee was for a rush orders, the portion above and beyond the standard fee is not eligible for a refund.
- Refunds are processed within 15-30 days. This allows time to verify that the requesting party has denied your assessment report.
Limits of Electronic Connections and Liability
You understand that there is a chance that internet or phone connection could be lost during your services. In the event your connection is lost, the counselor will attempt to contact you at the number you provided in your registration. If you have not heard from your counselor within five minutes, you agree to call our main number to reestablish connection and plan for continuance of your service. You also agree to hold NDSBS harmless with regard to any and all claims of damage from an electronic disconnection during services (also referred to in the Hold Harmless section of this agreement).
Respect of Copyrights
All assessment, evaluation, educational and other material made available on our website and provided in our offices is copyrighted. You may use our materials for the purpose of an NDSBS assessment, counseling or education services only. You agree not to use any aforementioned NDSBS materials in any other manner, including copying, reproducing, scanning, distributing, publishing, selling or otherwise conducting commercial activity with NDSBS materials. Efforts to engage in such activity are punishable by state and federal laws.
No Guarantees of Clinical Outcome
You agree that you are using NDSBS services at your own risk and without guarantee of any specific clinical assessment, counseling or education outcomes; that there is no warranty for our services; that third parties are not bound by any contracts or laws to accept or agree with our assessment , evaluation or other clinical conclusions.
To file a complaint with us, contact the Director of the practice at:NDSBS /Directions Counseling Group, Inc. 6797 North High Street, Suite 350 Worthington, Ohio 43085 (614) 888-9200
You will not be retaliated against for filing a complaint.
Acknowledgement of Receipt of Notice of Privacy Practices
I acknowledge my receipt of New Directions Substance and Behavioral Services’ Notice of Privacy Practices (revised and effective November 8, 2005) . It is included not only in this Consent for Service Agreement (see link) but is also available on our website and in our office for any client to access at any time.
Disputes and Jurisdiction
Notice of Changes
NDSBS may notify clients of changes or additions to its services by publishing such notice on the NDSBS website. Clients may give notice to NDSBS at any time by any of the following:
Email: firstname.lastname@example.org Fax: 614-888-3239 U.S. Mail: NDSBS 6797 N. High St. Ste. 350, Worthington, OH 43085
Modifications / Entire Agreement