forms & practice information
Useful information and required forms.
A list is below so you can easily find your way to the one(s) you need for now.
Forms are shown here for your information and ongoing reference. Copies are available through secure communication. Just ask.
list of contents
Step by Step
Details about beginning the connection process.
Telehealth - General Tips - TherapyNotes and Tele-health
Details about working with TherapyNotes service.
HIPAA Privacy Notice
For all clients - new and existing
A complete and compact explanation of your rights and limits.
You will be asked to sign a copy.
Communications Policy 2025 - Current
Provides understanding to better inform your ability to give consent. Explains how we will and will not communicate. You will be asked to sign a copy.
step by step
How We Get Started
We have talked. We have decided to establish at least a first appointment. Now there are the official things to do. Always happy to explain and it helps to have such things in writing for easier reference.
You cannot download the forms from here.
I will send them to you within the secure portal.
First - you give me a private-yours-only email address. And date of birth.
Second - I set you up as a client so that TherapyNotes can send you an invitation with a link to join.
Third - you accept the invitation and follow their directions. I will be notified. Helpful to add appointmentreminders@therapyportal(dot)com to your address book. Also add 512.768.2553 to your phone as the number for text appointment reminders. You CANNOT text me at this number.
Fourth - I send you all the forms shown on this page plus a few others: Intake Questionnaire & Consent for Treatment; Medication & Supplement Information; Insurance Information (if using insurance); and Credit Card Information - Authorization to Secure Payment. Most forms require reading and a signature. Others require you to provide useful information. All forms are required.
Fifth - you complete and return all forms through the portal.
Sixth - we set or confirm our first appointment. This initial session will be for 80 minutes. I will create the appointment and the invitation will be sent.You will receive both a text reminder and an email reminder.
Seventh - I send the ongoing assessment forms that we will use to track your progress and experience. Just print these out to have available. There is no need to try and complete them ahead of time. We will be doing assessments as we go along.
telehealth - general tips
Getting Started with TherapyNotes
I am now using TherapyNotes, a secure video service for online sessions. I chose TherapyNotes because it’s user friendly and has robust features and support. That said, there are some very important things you’ll need to know in order to avoid the potential frustration of not being able to connect at our scheduled appointment time.
If I have added you as a client - the system automatically generates an email that contains a link that you MUST click on to accept the invitation and join TherapyNotes. When you click the link, you’ll create your password and type in some other information. That first email might go to your junk/spam/clutter file, so go ahead and look for that at your earliest convenience.
Consider updating your contact information so that notices do not go to your spam folder.
therapyportal.com for invitations and notices
512-768-2553 for text reminders and notices
As soon as you have your log in information, you can log into TherapyNotes. The dashboard will list your appointment details after I schedule it with a green join button that is available 2 hours prior to your appointment. The portal also has a menu on the left called support, which can further answer any questions.
If you’re using a PC, Mac, or Android device, please use Chrome, Firefox, or Safari version 12.2 or greater. If you are using an iPhone or iPad, use Safari 12.2 or higher.
Rebooting your computer before a session is a good idea especially if you’ve used other applications during the day that utilize your speakers/camera/microphone - not required but it’s often helpful with some systems.
Finally, keep in mind that when using TherapyNotes, the more bandwidth you have available, the better your connection will be. Therefore, if you’re planning on using a phone or tablet, connecting to Wi-Fi will vastly improve the session.
Disconnections may occur. If we get disconnected, I’ll restart the session on my side. If you don’t see me in a few minutes, go back to the Dashboard and click the green join button again. I will call you if more than a few minutes have elapsed.
We can learn to do this.
Appointments (regardless of type or location) are scheduled by phone calls/phone messages. Cancelations cannot be done in the TherapyNotes system. Cancelations still follow our cancelation policy agreement.
I’m looking forward to meeting with you using this technology. If you have any questions, feel free to call me.
214.824.2009
HIPAA - privacy notice
Health Insurance Portability and Accountability Act
This notice continues to be a separate form.
This notice describes how medical information about you may be used and disclosed and how you can get access to this information.
Please review it carefully.
In this Privacy Notice, “medical information” and “psychological information”
mean the same as “health information.” Health information includes any
information that relates to: 1) your past, present, or future physical or
mental health or condition; 2) providing health care
to you; or 3) the past, present, or future payment for your health care.
Protecting Your Privacy:
Counselors must always manage psychological records with great concern for
privacy and confidentiality. I am required by law to protect the privacy of
your health information. This means that I will not use or disclose your
health information without your authorization except
in the ways I tell you in this notice. If I wish to use or disclose your
health information in ways other than those stated in this notice, I will ask
you for your written authorization. If you give such an authorization, you
may revoke it at any time, but I will not be liable for uses or disclosures
made before you revoked your authorization.
Although the security of psychological records has continuously been
addressed by Counseling Codes of Ethics as well as by State and Federal laws,
the rules have been considerably strengthened by the provisions of the Health
Insurance Portability and Accountability Act (HIPAA). The following
information provides details about the provisions of HIPAA and your rights
concerning privacy and your psychological records.
Who will observe these rules?
In my practice, the following individuals are required by HIPAA to comply
with the privacy rules:
• Me and any practice staff such as office manager/scheduler, etc..
• Any billing agency or collection agency that handles information about you
(name and address, diagnostic codes, treatment codes, and consultation
dates...but not actual clinical records)
YOUR RIGHTS REGARDING PSYCHOLOGICAL INFORMATION ABOUT YOU:
1) The Right to Inspect and Obtain a Copy of Your Psychological Record
Professional records constitute an important part of the therapy process and
help with the continuity of care over time. According to the rules of HIPAA,
your consultations are documented in two ways: 1) The Clinical Record
(required), which includes the date of your consultations, your reasons for
seeking therapy, your diagnosis, therapeutic goals, treatment plan, progress,
medical and social history, treatment history, functional status, any past
records from other providers, and any reports to your insurance carrier; and
2) Psychotherapy Notes (optional), which consist of specific content or
analyses of therapy conversations (some of which may include sensitive
information you have revealed that is not required to be included in your
Clinical Record) and therapist’s notes that may assist in treatment.
Psychotherapy Notes, if created, are never disclosed to third parties, HMOs,
insurance companies, billing agencies, patients, or anyone else. If your case
manager or insurance company requests to see the psychotherapy notes, you
have a choice about consenting (signing a Release of Information form) or
denying access to them. If you refuse, it will not affect your coverage or
reimbursement in any way, and your insurance company or HMO is obliged to
provide payment, as usual.
2. The Right to Request a Correction or Add an Addendum to Your Psychological
Record Correction 3. The Right to an Accounting of Disclosures of Your
Psychological Information to Third Parties 4. The Right to Request
Restrictions on How Your Information is Used
5. The Right to Request Confidential Communications
6. The Right to a Copy of This Notice upon Request
7. The Right to Withdraw Permission to Disclose Health Information
8. The Right to File a Complaint You have the right to file a complaint if
you believe your privacy rights have been violated. Complaints must be filed
in writing, and may be addressed directly to your therapist, or to the
Secretary of the Department of Health and Human Services (address: Office for
Civil Rights, 200 Independence Ave., S.W. Washington, DC 20201). If you have
any questions or concerns about this notice or your health information
privacy, please do not hesitate to address them during session or contact my
office by telephone.
9. The Right to be Notified in There is a Breach of Your Unsecured PHI You
have a right to be notified if: (a) there is a breach (a use or disclosure of
your PHI in violation of the HIPAA Privacy Rule) involving your PHI; (b) that
PHI has not been encrypted to government standards; and (c) our risk
assessment fails to determine that there is a low probability that your PHI
has been compromised.
10. The Right to Restrict Disclosures When You Have Paid for Your Care Out-
of-Pocket -
You have the right to restrict certain disclosures of PHI to a health plan
when you pay out-of- pocket in full for services.
I understand that this Privacy Notice is available at any time on DeborahBeckman.com print name & sign below & date
______________________________________________________________________
My signature above represents that I have read and understand my rights under
HIPAA.
Worth knowing
Your privacy matters. Much has been done to establish the careful protection outlined in HIPAA
To adore - cherish, honor, revere, venerate, or to have a great affection for
To endure - to bear patiently, to last or continue to exist
partial definitions from the Free Dictionary by Farlex
