Forms, Statements, & Requirements

HIPAA Statement

Counseling/Psychotherapy Services are considered Protected Health Information (PHI) and each client’s record is covered by the Health Insurance Portability and Accountability Act (HIPAA). Alamo Heights Counseling, Inc. also provides other services that, while confidential, are not related to health information and are therefore not covered by HIPAA. Services we provide that are NOT covered by HIPAA are 1) Custody Evaluations and Adoption Studies 2) Supervised Visitation Monitoring, in both DFPS cases and district court family law matters 3) Parent Facilitation and/or Parent Coordination 4) Divorce Impact Studies 5) Mediation 6) Faciliation of Collaborative Law Matters, including Collaborative Divorce.

If you are a counseling/psychotherapy client, you were provided a copy of our HIPAA Privacy Policy with your intake paperwork. Our Privacy Policies were most recently updated on 1/1/2022. If you wish to view our updated Privacy Policy, you may download a blank copy of the intake paperwork from the “counseling documents” area below or you may log in to your client portal account. To access the client portal, you will be navigating away from the Alamo Heights Counseling website. You may access the client portal by clicking on the below link:

Log In to Portal

No Surprises Act Statement

Effective January 1, 2022, the No Surprises Act, which was passed as part of the Consolidated Appropriations Act of 2021, is designed to protect clients from surprise bills for emergency services at out of network facilities of for out-of-network providers at in-network facilities, holding them liable only for in-network cost sharing amounts. The No Surprises Act also enables uninsured clients to receive a good faith estimate of the cost of care.

As Alamo Heights Counseling, Inc. endeavors to be in network with all health insurance companies, Medicaid plans, and employee assistance plans, for the most part the No Surprises Act has not changed our billing procedures much. We have always charged only the client’s insurance company’s allowable rate. In the unlikely event that a prospective client is using an insurance plan that we have not yet been able to join, we will 1) provide a No Surprises Act compliant Good Faith Estimate prior to the client’s first appointment or within 72 hours of discovering that we are not in network with the client’s plan and 2) will contact the insurance plan to begin the credentialing process to join the insurance company’s panel of in-network providers. For clients who do not have health insurance, choose not to use their insurance, or choose not to disclose that they have insurance, the cost for counseling is $175.00 per scheduled hour, with the understanding that an hour may be 53-55 minutes rather than exactly 60 minutes. There are no additional costs. Payments are collected at the time the services are rendered, so there are no surprise bills at a later time.

If you are a current counseling/psychotherapy client, you may have signed up for a “patient portal” through the EHR we use, Theranest. Theranest is an independent practice manage software. To access the patient portal, you will be navigating away from the Alamo Heights Counseling website. If you would like to access Theranest’s patient portal, you may do so by clicking on the below link:

Log In to Portal

Policy Regarding Minor Clients

Alamo Heights Counseling requires parents (or legal guardians) of minor children to provide certain specific information regarding parental rights and/or guardianship. Specifically, our intake paperwork requires that a parent designate one of the following: A) there are no legal documents affecting a parent-child relationship; B) there are legal documents and they are provided at or before the first appointment; or C) there are legal documents and the parent acknowledges that the child will not be seen until the legal documents have been turned in.

The reasons for this policy are many. It is important that we know that the person bringing a child for services is the person who has the legal right to consent to services. It is also required by our Ethics Codes. The LPC Ethics code, Section 681.4.1(v) states, in part, “Prior to the commencement of counseling services to a minor client who is named in a custody agreement or court order, a licensee must obtain and review a current copy of the custody agreement or court order, as well as any applicable part of the divorce decree. A licensee must maintain these documents in the client’s record and abide by the documents at all times.” The LMFT Ethics Code, Section 801.44(c) states, in part, “A licensee must make reasonable efforts to determine whether the conservatorship, guardianship, or parental rights of the client have been modified by a court. Before the commencement of therapy services to a minor client who is named in a custody agreement or court order, a licensee must obtain and review a current copy of the custody agreement or court order in a suit affecting the parent-child relationship. A licensee must maintain these documents in the client’s record.”

Parents may or may not have been asked to provide these documents at other providers’ offices. Parents are reminded that pediatricians, dentists, and other types of professionals are not licensed professional counselors or licensed marriage and family therapists. Other professionals are governed by different laws and ethics codes than LPCs and LMFTs. Because these requirements are defined by the ethics code, no exceptions will be made to this policy. Parents who cannot locate these documents or prefer not to provide these documents will not be able to schedule their children at this practice until and unless they are able or willing to do so.

Downloadable Printable Forms

Background Check Forms

All employees and contractors of Alamo Heights Counseling must pass a background check run by DFPS. The first step in applying for employment or a contract with Alamo Heights Counseling is to complete the background check forms below so that we may have DFPS clear the individual’s background. These forms are provided for the convenience of applicants only and do not constitute an offer of employment or contract.

DFPS form 2970c Download PDF
DFPS form 2971c Download PDF
Counseling Intake Packets
(Note: If you are able to log in to the TheraNest Portal, please do NOT download and print a packet. Printable forms are for clients who have no other means to complete the packet.)
Adult intake packet Download PDF
Child intake packet Download PDF
Child in foster care intake packet Download PDF
Adult intake packet (in Spanish) Download PDF
Child intake packet (in Spanish) Download PDF
HIPAA Release Form Download PDF