Four Points Counseling Center Service Policies

Revised: January 2025

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Terms and Conditions

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Website Use

By accessing the Four Points Counseling Center website and using our services, you agree to be bound by these Terms of Service (“Terms”). If you do not agree, please do not use our services.

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Data Security & Usage (Colorado Compliance)
In compliance with Colorado law, we maintain reasonable security procedures and practices appropriate to the nature of the information we collect to protect your personal information from unauthorized access, destruction, use, modification, or disclosure. However, no method of transmission over the Internet is 100% secure. 

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Intellectual Property
All content on this site, including text, graphics, logos, and software, is the property of [Company Name] or its content suppliers and protected by U.S. and international copyright laws.

 

Website User Conduct: You agree not to use the website and its features for any unlawful purpose, to upload harmful code, or to disrupt the servers or networks connected to our services.

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Consent to Treatment

1. Professional Disclosure
Four Points Counseling Center (Four Points) employs mental health professionals licensed under the Colorado
Department of Regulatory Agencies. Therapists hold a master's degree in mental health counseling, social
work or a related field and have completed the following requirements.

• Licensed Clinical Social Workers: 3360 hours over 24 months and 96 supervision hours

• Licensed Marriage and Family Therapists: 2000 hours over 24 months and 100 supervision hours

• Licensed Professional Counselors: 2000 hours over 24 months and 100 supervision hours

Four Points also employs licensure candidates, including Social Worker Candidates, Marriage and Family Therapist Candidates, and Licensed Professional Counselor Candidates who have received the degrees required by their fields and are completing the requirements for licensure. Therapist interns and practicum students are enrolled in a CACREP accredited graduate program in counseling, social work or a related field. Licensure candidates, interns and practicum students practice under the supervision of a licensed therapist employed by or contracted with Four Points. Therapists are licensed to practice in Colorado and only authorized to provide services within state boundaries, which includes telehealth services.

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2. Disclaimer of Warranties

Our services are provided without warranties of any kind, either express or implied. Four Points does not guarantee outcomes and may provide referrals in the interest of your needs. Minors age 12 and older in Colorado may consent to treatment.

3. You Have the Right

• To receive information about your therapy in a way that is easy to understand including methods,
  techniques, anticipated treatment duration and applicable fee structure.

• To collaborate on treatment goals and participate in an individualized treatment planning process.

• To seek a second opinion from another mental health professional, refuse services, or terminate therapy at any time.

4. Cancellation Policy
Cancellation is requested with at least 24 hours notice. Late cancellations and appointments missed without
notice (no shows) will incur a fee equal to the full rate of the service. Saturdays, Sundays and federal holidays
are not considered business days. Notice provided on these days is considered to be received the next
business day. Due to Colorado Medicaid regulations, clients with Medicaid are not subject to these fees.

5. Electronic Communication
Text and email communication is used for limited reasons. Four Points takes privacy seriously and cautions that
sending unencrypted information creates security risks. Others may access devices or accounts or disclose that
you receive mental health services. Communicating with therapists via text message is permitted for scheduling
only. You may receive electronic communication for the following reasons: Appointment reminders, billing and
insurance matters, and scheduling and administrative communications. If you have concerns about
communication you receive, please email info@fourpointscc.com.

6. Professional Relationship
Mental health professionals are bound by the ethics codes of the applicable regulatory boards. This includes holding the boundaries of the professional relationship. It is a violation for a therapist to develop a friendship, sexual relationship or romantic relationship with a client. It is never appropriate for a therapist to be physically
intimate with a client. Therapists are unable to accept requests to connect on social media. Treatment typically
ends as the result of planning between client and therapist. Exceptions include but are not limited to misalignment between therapist and client, clinical need for a higher level of care, threatening or abusive behavior or communication to Four Points staff, and nonpayment of services.

 

7. Your Health Information

• Confidentiality is maintained in compliance with the Health Insurance Portability and Accountability Act (HIPAA).

• Sharing information with other clinicians may be needed as part of treatment or if you seek care from another provider. Your therapist may consult with another mental health professional. Your identity is not revealed without consent and your privacy is protected by that professional.

• State law allows parents of minors under 15 to access healthcare information unless a court restricts
  access.

• Records are the sole property of Four Points, intended for therapist use, and stored for 10 years after treatment ends or seven years after minors reach age 18.

8. Legal Proceedings
Therapist involvement in legal matters has been shown to be detrimental to the therapeutic relationship. You
agree to refrain from involving your therapist in legal proceedings. If subpoenaed, no statements of clinical
judgment will be issued. Time will be billed at $250/hour including but not limited to preparation and travel time.

9. Grievances
We hope to address concerns by working with you directly. You are welcome to discuss concerns with your
therapist or with management. You may also file a complaint with the Department of Regulatory Agencies at
800-886-7675 or DORA_customercare@state.co.us.

10. Crisis Resources
Four Points is unable to provide emergency services. Your therapist may be available after hours within reason
via their direct number. If you are in a life-threatening situation, call 911 or go to an emergency room or crisis
center. Services may incur a cost to you and insurance may or may not contribute.
MCR Emergency: 2500 Rocky Mountain Ave, Loveland CO Crisis Services: 844-493-8255
SummitStone Walk-In Clinic: 1217 Riverside Ave, Fort Collins National Suicide Line: 800-273-8255

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11. Changes to Terms
We reserve the right to modify these Terms at any time. We will notify you of any changes by posting the new Terms on our site.

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12. Contact Us
If you have any questions about these Terms, please contact us at: [Email/Contact Info].

13. Informed Consent to Treatment
I give Four Points Counseling Center permission to conduct mental health services including therapy services.
Risks of receiving therapy include but are not limited to experiencing discomfort, vulnerability, or distress due to
the processing of events, memories and personal difficulties. Benefits include but are not limited to
improvement in symptoms, relationships and coping ability.

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My signature indicates my consent to the terms of the use of the website and consent to treatment by Four Points Counseling Center. I understand and agree to the information in this disclosure. I understand I may ask questions about the information in this document at any time.

Client _________________ Date of Birth _______ Parent/Representative Name __________________
Signature ___________________ Date _______

 

 

Notice of Privacy Practices

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Effective November 1, 2021: This notice outlines the policies of Four Points Counseling Center (Four Points)
regarding the use and disclosure of protected health information (PHI) and the way you may access this
information. PHI refers to information about you, including demographic information, that may be used to identify you. PHI includes information related to your past, present or future physical or mental health and conditions related to physical or mental health; the provision of healthcare services; or the past, present or future payment for the
provision of healthcare services. Please review this document carefully.

This notice may be changed at any time. The current version will be the version in effect for all health
information collected and maintained by Four Points. You may obtain a copy by emailing Four Points at
info@fourpointscc.com or calling 970-682-1337.

Information is released only in accordance with state and federal law. Four Points is permitted to disclose PHI for
the healthcare functions of providing services, collecting payment for services, and conducting healthcare
operations.

Four Points may use and disclose PHI for the following reasons:

• To provide, manage and coordinate care with entities involved in your care and to communicate with
  referral sources.

• To collect fees, verify insurance coverage and process claims.

• To schedule appointments and manage routine administrative functions regarding your care and conduct internal audits to improve your care.

• To attend to compliance, audit, investigation and licensing requirements.

• Other Uses and Disclosures Without Your Consent: Mandatory reporting, emergencies and criminal activities; inquiries by coroners, medical examiners and related professionals; research purposes (rare
  and requires a rigorous approval process); and any and all other uses and disclosures as permitted by
  law.

Information shared during services is protected as confidential under state law. Therapists cannot be forced to
make disclosures without consent with some exceptions (12-43-218 C.R.S.) which do not require consent: Imminent threat of harm to self or others; grave disability; suspected abuse/neglect of minors,elders, or disabled persons; a court order involving the therapist; an official complaint or lawsuit against the therapist; court-mandated treatment; criminal/delinquency proceedings (exception:13-90-107 C.R.S.); and additional exceptions as permitted under state law.

Your Rights

• Confidential Communication: You have the right to request where you are contacted and for communication to occur in a specific, limited, confidential manner. You may state your preference regarding electronic communication in the Disclosure and Consent to Treatment. Four Points will accommodate all reasonable requests.

• Obtain and Release Records: You may submit a written request for an electronic or paper copy of your record or
  request to have records sent to a third party. We may provide a copy or summary within 30 days of the request.
  We may charge a reasonable cost-based fee. You have the right to revoke releases of information in writing. Revocation is not valid to the extent that Four Points has acted in reliance upon previous authorization.

• Request an Amendment: You may request to correct information about you that you think is incorrect orincomplete. Requests may not result in formal modification to the record, however the request for the correctionwill be added to the health record as an addendum. Please contact Four Points for information about making thisrequest.

• Accounting of Disclosures: You may obtain a list of disclosures of PHI for six years prior to the date of therequest, including the recipient and purpose. All disclosures will be included except those regarding payment forservices, healthcare operations, and certain other disclosures, such as those requested by you with acorresponding written release of information. One accounting per year will be provided without charge. Four Points charges a reasonable, cost-based fee for additional requests within the same 12-month period. Pleasecontact Four Points for information about making this request.

• Request Restrictions on PHI Uses and Disclosures: You may request that we not use or share certain healthinformation for treatment, payment, or operations. Four Points is not required to agree to the request and maydecline if it would affect your care or the legal requirements of Four Points.

• File a Complaint: If you feel your rights have been violated and wish to file a complaint, you may contact FourPoints directly at info@fourpointscc.com or 970-682-1337. You may also contact the US Department of Healthand Human Services. Please know we will not retaliate against you in any way for filing a complaint.For questions about

 

Governing Law and Jurisdiction

These Terms shall be governed by and construed in accordance with the laws of the State of Colorado, without regard to its conflict of law provisions.

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