Patient Rights and Responsibilities

This Notice describes how your medical information may be used and disclosed and how you can get access to this information.

Effective Date: June 30, 2025

We are committed to providing high-quality, respectful, and person-centered care. As a client of our practice, you have certain rights and responsibilities that help ensure safe, effective, and respectful treatment.

Your Rights as a Patient

You have the right to:

  • Be treated with respect, dignity, and without discrimination of any kind.

  • Receive services in a safe, supportive, and accessible environment.

  • Understand your condition, treatment options, and the purpose of any recommended therapy or intervention.

  • Ask questions and receive clear answers about your care.

  • Participate in developing your therapy goals and treatment plan.

  • Refuse or discontinue services at any time, understanding the potential impact on your progress.

  • Request a second opinion or referral.

  • Receive a Good Faith Estimate of expected charges upon request (if uninsured or self-pay).

  • Expect that your personal health information will be handled in accordance with HIPAA and privacy laws.

  • Access your therapy records in a reasonable time frame, with appropriate documentation.

  • Voice concerns or complaints without fear of retaliation and have them addressed promptly.

Your Responsibilities as a Patient

You are responsible for:

  • Providing accurate and complete health and personal information, including changes to your condition, medications, or treatment.

  • Arriving on time for appointments and giving adequate notice if you need to cancel or reschedule (as per our cancellation policy).

  • Participating actively in your care, including following through on home programs or therapist recommendations.

  • Treating your therapist and any staff with courtesy and respect.

  • Asking questions if you do not understand something related to your care.

  • Informing us of any changes to your insurance, contact information, or payment method.

  • Paying for services as agreed, including co-payments, deductibles, or fee-for-service charges.

  • Respecting the privacy and safety of other clients, if seen in a shared or community space.

If you have any questions about your rights or responsibilities, or if you’d like to speak with someone about your care, please contact:

Katherine Jackson, OTR/L
Phone: 847.238.2008
Email: kj@kjacksontherapy.com