Privacy Act Statement

Consumer & Client Resources

We believe in transparency, ethical care, and your right to access information and support. The following resources are provided for your reference.

CMS is authorized to collect the information on this form and any supporting documentation under section 2799B-7 of the Public Health Service Act, as added by section 112 of the No Surprises Act, title I of Division BB of the Consolidated Appropriations Act, 2021 (Pub. L. 116-260). We need the information on the form to process your request to initiate a payment dispute, verify the eligibility of your dispute for the PPDR process, and to determine whether any conflict of interest exists with the independent dispute resolution entity selected to decide your dispute. The information may also be used to: (1) support a decision on your dispute; (2) support the ongoing operation and oversight of the PPDR program; (3) evaluate selected IDR entity’s compliance with program rules. Providing the requested information is voluntary. But failing to provide it may delay or prevent processing of your dispute, or it could cause your dispute to be decided in favor of the provider or facility.

File a Consumer Complaint (State of Texas)

If you wish to file a consumer complaint with the State of Texas, you may do so through the Texas Attorney General’s Office:

Texas Attorney General – Consumer Protection
https://www.texasattorneygeneral.gov/consumer-protection

Contact the Licensing Board

For questions or concerns related to professional licensing, you may contact the Texas Behavioral Health Executive Council (BHEC):

Texas Behavioral Health Executive Council (BHEC)
https://bhec.texas.gov/contact-us/

Requesting Therapy Records

Clients—or a legal guardian requesting records for a minor—may submit a written request for therapy records at any time.

In accordance with Texas law, we will respond within 15 days by one of the following methods:

  • Making the information available for review

  • Providing a copy of the record

  • Informing you if the record does not exist or cannot be located

  • Explaining if ethical or legal considerations prevent all or part of the record from being released

While you are fully within your rights to request records, we encourage you to discuss your request with your therapist prior to submission. Releasing clinical records may involve therapeutic, ethical, and confidentiality considerations, and our goal is always to support the therapeutic relationship while honoring your rights.

This is especially important when:

  • Requesting records for a minor in your care

  • Using records for legal or court-related matters

We are committed to handling all record requests thoughtfully, respectfully, and in accordance with professional and ethical standards.