Privacy Policy & Terms and Conditions
Privacy Policy
Effective Date: April 2026
We value your privacy and are committed to protecting your personal information. When you submit your contact information through this form, we collect your name, email address, phone number, and any additional details you choose to provide. This information will be used solely for the purpose of responding to your inquiries and providing you with the best possible service.
Information Usage
Communication: We will use your contact information to respond to your inquiries, provide updates, and communicate any necessary information regarding our services.
Service Improvement: Your feedback helps us improve our services. Any information you provide may be used to enhance our offerings and customer experience.
Third-Party Sharing
We do not sell, trade, or otherwise transfer your personal information to outside parties. This does not include trusted third parties who assist us in operating our website, conducting our business, or servicing you, provided those parties agree to keep this information confidential.
Cookies
Our website may use cookies to enhance your browsing experience. Cookies are small files that a site or its service provider transfers to your computer’s hard drive through your web browser (if you allow) that enables the site’s or service provider’s systems to recognize your browser and capture and remember certain information.
Your Consent
By using our site and submitting your information through this form, you consent to our website’s privacy policy and terms of service.
Changes to Our Privacy Policy
We reserve the right to update or modify this privacy policy at any time. Any changes will be posted on this page, and the date of the latest revision will be indicated.
Notice of Privacy Practices
Your Information. Your Rights. My Responsibility.
This notice describes how personal health information (PHI) about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Your Rights
You have the right to:
Get a copy of your paper or electronic health record
Correct your paper or electronic health record
Request confidential communication
Ask me to limit the information I share
Get a list of those with whom I’ve shared your information
Get a copy of this privacy notice
Choose someone to act for you
File a complaint if you believe your privacy rights have been violated
Your Choices
You have some choices in the way that I use and share information as I:
Collaborate and consult with other professionals on your behalf
Tell family and friends about your condition
Provide you mental health care
Provide disaster relief or emergency mental health treatment
Our Uses and Disclosures
I may use and share your information as I:
Treat you
Run my practice
Coordinate treatment and comply with health plan requirements
Bill for your services and/or collect overdue payments
Comply with mandatory reporting laws
Respond to lawsuits and legal actions
Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and some of my responsibilities to help you.
Get an electronic or paper copy of your health record
You can ask to see or get an electronic or paper copy of your health record and other health information I have about you. Ask me how to do this.
I will provide a copy or a summary of your health information, usually within 14 days of your request. I may charge a reasonable, cost-based fee.
Ask me to correct your health record
You can ask me to correct health information about you that you think is incorrect or incomplete. Ask me how to do this.
I may say “no” to your request, but will tell you why in writing within 60 days.
Request confidential communications
You can ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
I will say “yes” to all reasonable requests.
Ask me to limit what I use or share
You can ask me not to use or share certain health information for treatment, payment, or business operations. I am not required to agree to your request, and may say “no” if it would negatively affect your care or my ability to practice.
If you pay for a service out-of-pocket in full, you can ask me not to share that information for the purpose of payment or business operations with your health insurer. I will say “yes” unless a law requires me to share that information.
Get a list of those with whom I’ve shared information
You can ask for a list (accounting) of the times I’ve shared your health information for six years prior to the date you ask, who I shared it with, and why.
I will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked me to make). I’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. I will provide you with a paper copy promptly.
Choose someone to act for you
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
I will make sure the person has this authority and can act for you before I take any action.
File a complaint if you feel your rights are violated
You can complain if you feel I have violated your rights by contacting me using the information on page 1.
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
I will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you can tell me your choices about what I share. If you have a clear preference for how I share your information in the situations described below, talk to me. Tell me what you want me to do, and I will follow your instructions.
In these cases, you have both the right and choice to tell me to:
Share information with your family, close friends, or others involved in your care
Share information in a disaster relief or emergency situation
If you are not able to tell me your preference, for example if you are unconscious, I may go ahead and share your information if I believe it is in your best interest.
In these cases I never share your information unless you give me written permission:
Requests from family, friends, or others
Requests for copies of your records (unless accompanied by a subpoena)
Most sharing of psychotherapy notes
Our Uses and Disclosures
How do I typically use or share your health information?
I typically use or share your health information in the following ways.
Treat you
Although it is not my practice to do so without first informing you, I can use your health information and share it with other professionals for consultation.
Example: I may consult with another therapist about whether or not a particular treatment may be helpful, considering your diagnosis and history.
Although it is not my practice to do so without first informing you, I can use your health information and share it with other healthcare professionals who are treating you.
Example: I may ask your psychiatrist or primary care doctor about your overall health condition.
Run my business
I can use and share your health information to run my practice, improve your care, and contact you when necessary.
Example: I use health information about you to manage your treatment outcomes and monitor trends within my practice.
Example: I use health information about you to justify services in the event of an audit.
Bill for your services
I can use and share your health information to bill and get payment from health plans or other entities.
Example: I give information about you, such as a diagnosis, to your health insurance plan so it will pay for your services.
Example: I can give information about you, such as your address, to a collection agency if you acquire an outstanding balance.
How else can I use or share your health information?
I am allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as mandatory reporting for potential child abuse. I have to meet many conditions in the law before I can share your information for these purposes. For more information please reference the Consent for Services document.
Help with public health and safety issues
I can share health information about you for certain situations such as:
Reporting suspected child abuse or neglect
Preventing or reducing a serious threat to an identified person’s health or safety
Comply with the law
I will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that I am complying with federal privacy law.
Respond to lawsuits and legal actions
Although it is not my practice to do so without first discussing the situation with you, I can share health information about you in response to a subpoena or if required to do so by a judge.
My Responsibilities
I am required by law to maintain the privacy and security of your protected health information.
I will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
I must follow the duties and privacy practices described in this notice and give you a copy of it.
I will not use or share your information other than as described here unless you tell me I can in writing. If you tell me so, you may change your mind at any time. Let me know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of this Notice
I can change the terms of this notice, and the changes will apply to all information I have about you. The new notice will be available upon request, in my office, and on my website.
This notice was last updated on April 24, 2026.
Privacy Officer Contact
If you have any questions or concerns about this notice or about your privacy while receiving services, please contact me, the Privacy Officer.
Joyce Yung, Ph.D.
Licensed Psychologist, Founder, Clinical Director
Phone: 845-669-6855 Ext. 1128
I have been informed and understand the privacy practices. I understand that I can ask questions and address concerns regarding the privacy practices at any time.
Practice Policies
I have fully discussed with the treatment provider what is involved in psychotherapy and I understand and agree to the policies about scheduling, fees and missed appointments.
I understand that I am fully financially responsible for treatment, which, if I have health insurance, includes any portion of the treatment provider’s fees that are not reimbursed by my insurance.
I understand that I am fully responsible for payment of all sessions, that the frequency of billing will be before each session, and that I will be personally responsible for payment in full for any canceled session if I do not give Aweness Psychology at least 48 hours advance notice of the cancellation (please note that insurers don’t pay for canceled sessions).
Our discussion about therapy has included the treatment provider’s evaluation and diagnostic formulation of my problems, the method of treatment, goals and length of treatment, and information about record-keeping. I have been informed about and understand the extent of treatment, its foreseeable benefits and risks, and possible alternative methods of treatment. I understand that therapy can sometimes cause upsetting feelings to emerge, that I may feel worse temporarily before feeling better, and that I may experience distress caused by changes I may decide to make in my life as a result of therapy.
I understand that the treatment provider at Aweness Psychology cannot provide emergency service. The treatment provider has told me whom to call if an emergency arises and when the treatment provider is unavailable. In any case, I understand that in any emergency, I may call 911 or go the nearest hospital emergency room.
I understand that information about psychotherapy is almost always kept confidential at Aweness Psychology and not revealed to others unless I give my consent. There are a few exceptions. Details about certain of those exceptions follow:
The treatment provider is required by law to report suspected child abuse or neglect to the proper authorities. The treatment provider is also mandated to report to the authorities patients who are at imminent risk of harming themselves or others for the purpose of those authorities checking to see whether such patients are owners of firearms, and if they are, or apply to be, then limiting and possibly removing their ability to possess them.
If I tell the treatment provider that I intend to harm another person, the treatment provider must try to protect that person, including by telling the police or the person or other health care providers. Similarly, if I threaten to harm myself, or my life or health is in any immediate danger, the Treatment provider will try to protect me, including by telling others such as my relatives or the police or other health care providers, who can assist in protecting or assisting me.
If I am involved in certain court proceedings the treatment provider may be required by law to reveal information about my treatment. These situations include child custody disputes, cases where a therapy patient's psychological condition is an issue, lawsuits or formal complaints against the treatment provider, civil commitment hearings, and court-related treatment.
If my health insurance or managed care plan will be reimbursing me, they will require that I waive confidentiality and that Aweness Psychology give them information about my treatment.
The treatment provider at Aweness Psychology may consult with other psychotherapists about my treatment, but in doing so will not reveal my name or other information that would identify me unless specific consent to do so is obtained. Further, when the treatment provider is away or unavailable, another treatment provider or relevant staff at Aweness Psychology might answer calls and so will need to have access to information about my treatment.
If my account with Aweness Psychology becomes overdue and I do not pay the amount due or work out a payment plan, Aweness Psychology will reveal a limited amount of information about my treatment in taking legal measures to be paid. This information will include my name, patient identification number, address, dates and type of treatment and the amount due.
In all of the situations described above I understand that Aweness Psychology will try to discuss the situation with me, or notify me, before any confidential information is revealed, and will reveal only the least amount of information that is necessary.
If I am participating in a managed care plan, I have discussed with Aweness Psychology the plan's limits, if any, on the number of therapy sessions. I have discussed with Aweness Psychology my options for continuation of treatment when my managed care benefits end.
I understand that I have a right to ask Awness Psychology about the treatment provider’s training and qualifications and about where to file complaints about the treatment provider’s professional conduct.
By signing below I am indicating that I have read and understood this form and that I give my consent to treatment.
Court Policy & Fees
Court Policy:
Please be advised that the therapists, therapist interns, and staff of Aweness Psychology do not participate in person, by phone, or in writing in any court-related matter that the client of Aweness Psychology may be a party to or become a party to in any way. The therapists and interns of Aweness Psychology do not write letters regarding their client’s services to any entity, including court. The therapists and interns of Aweness Psychology at no time will offer an opinion or recommendation in any court matter, especially as it relates to custody.
Please be advised that should a therapist or intern from Aweness Psychology be court-ordered to appear in court or at a deposition, the fee stipulation is as follows:
$3,000 per day plus $300 per hour for travel to and from the court.
$300 per hour for preparation.
Please be advised that should a therapist or intern from Aweness Psychology be ordered by the court to write a letter, respond to a subpoena, or respond to any court-related activity, the time shall be billed at $300 per hour.
All therapists and interns of Aweness Psychology will NOT be ON-CALL at any time.
Should a case be trialed, or continued, the therapist will be paid in full for each day at the hourly rate of $300 per hour as well as an additional $1,000 per day as it hinders the therapist’s or intern’s ability to be available to their other clients.
The therapist must have a signed release prior to submitting records or appearing on a court matter, regardless of the subpoena.
All court fees must be received by cashier’s check 7 days prior to the court date. Should the court calendar the hearing for another date, the therapist or intern must be re-issued a new subpoena or court order with the new court hearing date.
Should the therapists or interns be on vacation, the party initiating the court order must take reasonable steps to avoid imposing an undue burden or expense on a person subject to the subpoena.
By signing and dating below, you understand and agree to the above-stated court policy and stipulation, including but not limited to the fee structure for all related court matters.
Working with Couples
If you are here to work on a relationship problem with a partner(s), please be advised that your provider does not have preconceived notions about whether you and your partner should stay together or part ways. It is important to explore such questions openly, honestly, and thoroughly. Once your goals for treatment are established, your provider will support you in achieving them, whatever they may be.
When working in couple therapy, it is imperative that both clients understand that if they wish to access their records during or after the completion of therapy, both participants must consent to the release of such records. This also includes court letters and testimony. Both participants must consent to the disclosure, otherwise, the therapist shall invoke privilege.
Please be advised that you are entrusting your provider at Aweness Psychology to use their professional judgment as it relates to individual confidences.
By working with Aweness Psychology, you are acknowledging that anything you communicate to your provider individually by phone, email, or any other means may be important to bring up and work on in a couple's therapy session, and your provider at Aweness Psychology reserves the right (but not the obligation) to do so.