Core Values Counseling, LLC
3000 NE Stucki Ave, Suite 230, Hillsboro, OR 97124
Phone: 503-869-8108

NOTICE OF PRACTICE POLICIES

Effective Date: January 28, 2026

APPOINTMENTS AND CANCELLATIONS

Please remember to cancel or reschedule 48 hours in advance. You will be responsible for the entire fee if cancellation is less than 48 hours.

The standard meeting time for psychotherapy is 50 minutes. Requests to change the 50-minute session needs to be discussed with the therapist in order for time to be scheduled in advance. Couples Sessions will be normally booked at 1 hour 20 min and the additional time will be the responsibility of the client. Additional 30 mins are charged at $75.

A $25.00 service charge will be charged for any checks returned for any reason for special handling.

PAYMENT POLICY AND AGREEMENT

My account should be paid in full prior to the next counseling appointment. I understand that a credit card/HSA card is required to be uploaded to my client profile prior to my first paid session. With the uploaded credit card, I give permission to my counselor to charge the card within 24 hours after the completion of the session. If the card declines for any reason, future sessions will be paused until the payment issue is resolved. I have read this Statement of Financial Responsibility. I understand that I am responsible for my bill, payable to Core Values Counseling, LLC.

Cancellations and re-scheduled session will be subject to a full charge if NOT RECEIVED AT LEAST 48 HOURS IN ADVANCE. This is necessary because a time commitment is made to you and is held exclusively for you. If you are late for a session, you may lose some of that session time.

TELEPHONE ACCESSIBILITY

If you need to contact your counselor between sessions, please contact our main office or send a message through Simple Practice Portal (preferable option). Someone will respond within 24 hours. Please note that Face-to-face sessions are highly preferable to telehealth sessions. However, in the event that you are out of town, sick, or need additional support, telehealth sessions are available. If a true emergency situation arises, please call 911 or any local emergency room.

SOCIAL MEDIA AND TELECOMMUNICATION

Due to the importance of your confidentiality and the importance of minimizing dual relationships, your counselor does not accept a friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc). Core Values Counseling believes that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of the therapeutic relationship. If you have questions about this, please bring them up when we meet and we can talk more about it.

ELECTRONIC COMMUNICATION

Core Values Counseling cannot ensure the confidentiality of any form of communication through electronic media, including text messages. If you prefer to communicate via unencrypted email or text messaging for issues regarding scheduling or cancellations, you will assume the risk involved in non-secure communication. While we try to return messages in a timely manner, we cannot guarantee immediate response and request that you do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies.

Services by electronic means, including but not limited to telephone communication, the Internet, facsimile machines, and e-mail is considered telemedicine by the State of Oregon. Telemedicine is broadly defined as the use of information technology to deliver medical services and information from one location to another. If you and your therapist chose to use information technology for some or all of your treatment, you need to understand that:

(1) You retain the option to withhold or withdraw consent at any time without affecting the right to future care or treatment or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled.
(2) All existing confidentiality protections are equally applicable.
(3) Your access to all medical information transmitted during a telemedicine consultation is guaranteed, and copies of this information are available for a reasonable fee.
(4) Dissemination of any of your identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without your consent.
(5) There are potential risks, consequences, and benefits of telemedicine. Potential benefits include, but are not limited to improved communication capabilities, providing convenient access to up-to-date information, consultations, support, reduced costs, improved quality, change in the conditions of practice, improved access to therapy, better continuity of care, and reduction of lost work time and travel
costs. Effective therapy is often facilitated when the therapist gathers within a session or a series of sessions, a multitude of observations, information, and experiences about the client. Therapists may make clinical assessments, diagnosis, and interventions based not only on direct verbal or auditory communications, written reports, and third person consultations, but also from direct visual and olfactory observations, information, and experiences. When using information technology in therapy services, potential risks include, but are not limited to the therapist’s inability to make visual and olfactory observations of clinically or therapeutically potentially relevant issues such as: your physical condition including deformities, apparent height and weight, body type, attractiveness relative to social and cultural norms or standards, gait and motor coordination, posture, work speed, any noteworthy mannerism or gestures, physical or medical conditions including bruises or injuries, basic grooming and hygiene including appropriateness of dress, eye contact (including any changes in the previously listed issues), sex, chronological and apparent age, ethnicity, facial and body language, and congruence of language and facial or bodily expression. Potential consequences thus include the therapist not being aware of what he or she would consider important information, that you may not recognize as significant to present verbally the therapist.

If for any reason professional communication occurs outside of session, either by email, phone or a requested letter to some other agency there will be a charge of $4.16 per minute.

MINORS

If you are a minor, your parents/guardians may be legally entitled to some information about your therapy. Your therapist will discuss with you and your parents/guardians what information is appropriate for them to receive and which issues are more appropriately kept confidential.

TERMINATION

Ending relationships can be difficult. Therefore, it is important to have a termination process in order to achieve some closure. The appropriate length of the termination depends on the length and intensity of the treatment. Your therapist may terminate treatment after appropriate discussion with you and a termination process if your therapist determines that the psychotherapy is not being effectively used or if you are in default on payment. Your therapist will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. If therapy is terminated for any reason or you request another therapist, we will provide you with a list of qualified psychotherapists to treat you. You may also choose someone on your own or from another referral source.

Should you fail to schedule an appointment for three consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, we must consider the professional relationship discontinued.

Core Values Counseling, LLC
3000 NE Stucki Ave, Suite 230, Hillsboro, OR 97124
Phone: 503-869-8108

NOTICE OF PRIVACY PRACTICES

Effective Date: Feb 16, 2026

This notice describes how your health information may be used and disclosed and how you can access this information. Please review it carefully.

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information (PHI) and to give you this Notice of our legal duties and privacy practices. We must follow the terms of this Notice currently in effect and notify you if a breach occurs that may have compromised the privacy or security of your PHI.

We may change this Notice and the changes will apply to all information we have about you. The new Notice will be available in our office and on our website.

How We May Use and Disclose Your Health Information

We typically use or share your PHI in the following ways:

For Treatment, Payment, and Health Care Operations

Treatment: To provide, coordinate, or manage your care. For example, we may consult with another provider about your care.
Payment: To bill and receive payment for services provided to you.
Health Care Operations: For our business operations, such as quality assessment and training.

Other Uses and Disclosures Without Your Authorization

We may use or disclose your PHI without your written permission in the following circumstances:

As Required by Law: When required to do so by federal, state, or local law.
Public Health and Safety: To report suspected abuse, neglect, or domestic violence; prevent or reduce a serious threat to anyone’s health or safety.
Health Oversight: For audits, investigations, inspections, and licensing.
Legal Proceedings: In response to a court or administrative order, or in response to a subpoena with certain protections.
Law Enforcement: To report a crime on our premises, or as required by law.
Coroners, Medical Examiners, and Funeral Directors: As needed to carry out their duties.
Research: For research purposes when approved by an institutional review board or privacy board.
Specialized Government Functions: For military, national security, or correctional institution activities.
Workers’ Compensation: To comply with workers’ compensation laws.

Uses and Disclosures That Require Your Authorization

We will obtain your written authorization for:

Most uses and disclosures of psychotherapy notes (except as allowed by law).
Most uses and disclosures for marketing purposes.
The sale of your PHI.

Other uses and disclosures not described in this Notice will be made only with your written authorization. You may revoke your authorization at any time in writing.

Uses and Disclosures You Can Limit or Object To

Family, Friends, or Others Involved in Your Care: We may share your PHI with individuals involved in your care or payment for your care, unless you object. You have the right to restrict or limit such disclosures.
Disaster Relief: To organizations assisting in disaster relief efforts, unless you object.

Special Protections for Substance Use Disorder (SUD) Records

If you receive substance use disorder (SUD) diagnosis, treatment, or referral services at Core Values Counseling, your health information is protected by federal law (42 CFR Part 2) in addition to HIPAA. These records have additional privacy protections:

Consent for Use and Disclosure: We will obtain your written consent before using or disclosing your SUD information for treatment, payment, or health care operations. Once given, this consent remains valid until you revoke it in writing.
Legal Proceedings: Your SUD records cannot be used or disclosed in any criminal, civil, administrative, or legislative proceedings against you without your specific written consent or a court order that complies with 42 CFR Part 2.
Redisclosure: If you authorize us to disclose your SUD information for treatment, payment, or health care operations, the recipient may further disclose it as allowed by HIPAA. However, the restriction on using your SUD records in legal proceedings against you still applies.
Accounting of Disclosures: You have the right to request a list of disclosures of your SUD information made for treatment, payment, or health care operations if these records are maintained electronically.
Breach Notification: If your SUD information is used or disclosed in an unauthorized manner, you will be notified as required by law.

Violation of these federal laws and regulations by this program is a crime. Suspected violations may be reported to appropriate authorities in accordance with federal regulations.

Federal law (42 CFR Part 2) does not protect any information about a crime committed by a patient, either at the program or against any person who works for the program, or about any threat to commit such a crime.

Your Rights

You have the following rights regarding your PHI:

1. Right to Access and Obtain Copies

You may inspect and obtain an electronic or paper copy of your health record and other health information we have about you. You may also direct us to send this information to a third party. We will provide a copy or summary within 30 days of your request (or sooner if required by law), and may charge a reasonable, cost-based fee.

2. Right to Request Restrictions

You may ask us not to use or share certain health information for treatment, payment, or operations. We are not required to agree, except if you pay out-of-pocket in full for a service and request that we not share information about that service with your health plan.

3. Right to Request Confidential Communications

You may ask us to contact you in a specific way (for example, at a different address or phone number). We will accommodate reasonable requests.

4. Right to Amend

If you believe your record is incorrect or incomplete, you may ask us to amend it. We may say “no,” but we will tell you why in writing within 60 days.

5. Right to an Accounting of Disclosures

You may request a list (accounting) of disclosures of your PHI made in the past six years, except for disclosures for treatment, payment, health care operations, and certain other disclosures. The first list is free each year; we may charge for additional lists.

6. Right to a Paper or Electronic Copy of this Notice

You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically.

7. Right to File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.

Additional Protections for Sensitive Information

Some types of information (such as mental health, substance use disorder, HIV/AIDS, and genetic information) may be subject to additional protections under state or federal law. We will comply with these requirements.

Electronic Communications and Individual Rights

Your Right to Request Restrictions on Disclosures to Health Plans: If you pay out-of-pocket in full for a service, you can request that we not share information about that service with your health plan.
Your Right to Direct Records to a Third Party: You may direct us to send your PHI to a third party of your choice, in writing, including through secure electronic means.
Your Right to Receive an Electronic Copy: You may request your records in the electronic format you prefer, if readily producible.
Your Right to Confidential Communications: You may request communications by unencrypted email or text message after being informed of the risks. We will honor your request if feasible.

Our Duties in Case of a Breach

If a breach of unsecured PHI occurs that may compromise your privacy or security, we will notify you promptly, as required by law.

Contact Information and Complaints

If you have questions or would like more information, please contact:

Core Values Counseling, LLC
Privacy Officer: Eric Walters
Phone: 503-869-8108
Address: 3000 NE Stucki Ave, Suite 230, Hillsboro, OR 97124

To file a complaint with the U.S. Department of Health and Human Services, visit: https://www.hhs.gov/hipaa/filing-a-complaint/index.html

Acknowledgment of Receipt

By signing or acknowledging electronically, you confirm that you have received and reviewed this Notice of Privacy Practices.

Opportunity to Register to Vote (Oregon requirement): https://vote.gov/register/or/