Effective Date: October 31, 2026

Your Information. Your Rights. Our Responsibilities.

This notice describes how health information about you may be used and disclosed and how you can obtain access to this information. Please review it carefully.

This Notice of Privacy Practices (“Notice”) applies to protected health information maintained by Forward Motion Therapy Services.

YOUR RIGHTS

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities.

Obtain a Copy of Your Health Record

You may ask to see or obtain an electronic or paper copy of your health record and other health information we maintain about you.

We will provide a copy or summary of your health information as required by applicable law. We may charge a reasonable, cost-based fee where permitted.

Certain records, including psychotherapy notes as defined by applicable law, may be subject to different access requirements.

Ask Us to Correct Your Health Record

You may ask us to correct health information about you that you believe is incorrect or incomplete.

We may deny your request under circumstances permitted by law. If we deny your request, we will provide an explanation as required.

Request Confidential Communications

You may ask us to contact you in a specific way—for example, at a particular telephone number or email address—or to send communications to a different address.

We will accommodate reasonable requests as required by law.

Ask Us to Limit What We Use or Share

You may ask us not to use or disclose certain health information for treatment, payment, or healthcare operations.

We are generally not required to agree to every requested restriction. If we agree to a restriction, we will comply with it except as permitted or required by law, including when information may be needed for emergency treatment.

If you pay for a healthcare service or item out of pocket in full, you may ask us not to disclose information about that service to your health insurer for payment or healthcare operations. We will honor that request when required by law unless disclosure is otherwise required by law.

Obtain an Accounting of Disclosures

You may request a list, or “accounting,” of certain disclosures of your health information made during the period permitted by law.

The accounting will not include certain disclosures, such as many disclosures for treatment, payment, or healthcare operations and other disclosures excluded by law.

We will provide one accounting within a 12-month period without charge. We may charge a reasonable, cost-based fee for additional requests where permitted by law.

Obtain a Copy of This Notice

You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically.

An electronic version may also be available on our website.

Choose Someone to Act for You

If you have given another person legal authority to act for you, such as through a healthcare power of attorney, or if someone is your legal guardian or personal representative, that person may exercise rights regarding your health information as permitted by law.

We may verify the person's authority before taking action.

File a Complaint

You may file a complaint with Forward Motion Therapy Services if you believe your privacy rights have been violated.

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.

We will not retaliate against you for filing a privacy complaint.

YOUR CHOICES

For certain health information, you may tell us your preferences regarding what we share.

When applicable, you may have choices regarding sharing information with family members, friends, or others involved in your care or payment for your care.

If you are unable to tell us your preference—for example, because of an emergency—we may disclose information when permitted by law if we determine that doing so is in your best interest.

Marketing and Sale of Information

We will obtain your written authorization before using or disclosing your protected health information for purposes requiring authorization under applicable law.

We will not sell your protected health information in circumstances where HIPAA requires your written authorization.

OUR USES AND DISCLOSURES

We may use or disclose your health information in the following ways.

Treatment

We may use your health information and share it with other professionals involved in your treatment when permitted by law.

For example, we may communicate with another healthcare provider involved in coordinating your care.

Running Our Practice

We may use and disclose your health information for healthcare operations necessary to operate our practice and improve services.

Examples may include quality assessment, administrative functions, compliance activities, supervision when permitted, and other healthcare operations authorized by law.

Billing and Payment

We may use and disclose health information to bill and obtain payment for services.

For example, when insurance is used, we may provide information to a health insurer or other payer as necessary to process a claim, determine eligibility, obtain authorization, or receive payment.

Public Health and Safety

We may disclose health information for certain public-health and safety purposes when permitted or required by law.

These purposes may include preventing or reducing a serious threat to health or safety, reporting certain suspected abuse or neglect, and other legally authorized public-health activities.

Complying With the Law

We may disclose health information when federal, state, or other applicable law requires us to do so.

Health Oversight Activities

We may disclose information to authorized health oversight agencies for activities permitted by law, such as audits, investigations, inspections, licensing matters, or other oversight activities.

Workers' Compensation and Government Requests

We may disclose health information as authorized by and to the extent necessary to comply with workers' compensation laws and certain lawful government requests.

Law Enforcement and Legal Proceedings

We may disclose health information for law-enforcement purposes, in response to certain court or administrative orders, subpoenas, discovery requests, or other lawful processes when disclosure is permitted or required by law.

Because mental health records may receive additional protection under state or federal law, we will apply applicable heightened confidentiality requirements when required.

Research

We may use or disclose health information for research only when applicable legal requirements have been satisfied.

Medical Examiners and Funeral Directors

We may disclose health information to a coroner, medical examiner, or funeral director when permitted or required by law.

MENTAL HEALTH AND PSYCHOTHERAPY INFORMATION

Mental health information may receive additional protections under federal or state law.

Psychotherapy notes, as specifically defined under HIPAA, generally receive additional protection and ordinarily require authorization for uses and disclosures except where otherwise permitted by law.

Where applicable state law provides greater privacy protection than HIPAA, Forward Motion Therapy Services will comply with the more protective applicable requirement.

SUBSTANCE USE DISORDER RECORDS

Certain substance use disorder treatment records may receive additional confidentiality protection under federal law, including 42 CFR Part 2.

To the extent Forward Motion Therapy Services maintains records subject to 42 CFR Part 2, those records will be used and disclosed in accordance with applicable requirements.

Information protected by Part 2 will not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you except as permitted under applicable law, including when legally sufficient consent or an appropriate court order and subpoena are obtained when required.

ELECTRONIC COMMUNICATIONS, CLIENT PORTAL, AND TELEHEALTH

Forward Motion Therapy Services may use electronic systems for telehealth, client-portal services, scheduling, billing, and communications.

We take reasonable measures and use appropriate safeguards to protect health information transmitted or maintained electronically.

Clients should also take reasonable steps to protect their privacy when using telehealth or electronic communications, including using private locations, secure devices and networks, and safeguarding passwords and portal credentials.

Ordinary email and SMS/text messaging may carry privacy risks. We encourage the use of secure communication methods for sensitive clinical information when available.

OUR RESPONSIBILITIES

Forward Motion Therapy Services is required by law to maintain the privacy and security of protected health information.

We will notify affected individuals as required by law if a breach occurs that may have compromised the privacy or security of protected health information.

We must follow the privacy practices described in the Notice that is currently in effect.

We will not use or disclose your health information other than as described in this Notice unless you authorize us to do so in writing or another use or disclosure is permitted or required by law.

When your written authorization is required and you provide it, you generally may revoke that authorization in writing, subject to applicable legal limitations.

CHANGES TO THIS NOTICE

We may change the terms of this Notice and our privacy practices.

Changes may apply to health information we already maintain as well as information we receive in the future, as permitted by law.

When we materially change this Notice, the revised Notice will be made available upon request and posted on our website as required.

QUESTIONS OR PRIVACY COMPLAINTS

If you have questions regarding this Notice, wish to exercise a privacy right, or wish to file a complaint with Forward Motion Therapy Services, contact:

Privacy Officer
Forward Motion Therapy Services
Email: info@forwardmotiontherapyservices.com
Phone: 954-871-2322
Website: ForwardMotionTherapyServices.com

You may also submit a complaint to the U.S. Department of Health and Human Services Office for Civil Rights.

Forward Motion Therapy Services will not retaliate against you for filing a complaint.

Effective Date: October 31, 2026