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Политика конфиденциальности

c/o Natalya Yanovich LifeWorksWithNat, LLC

NOTICE OF PRIVACY PRACTICES

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

I am dedicated to maintaining the privacy of your personal information as part of providing professional care. I am required by law to keep your information private. These laws are complicated, but I must give you this important information. If you have any questions about this notice, please bring them to my attention.

How I use and disclose your protected information with your consent.

I will use the information I collect about you mainly to provide you with mindset coaching and/or hypnotherapy, to arrange payment for my services, and for some other business activities. After you have read this notice, I will ask you to sign a consent form to let me use and share your information in these ways. If you do not consent and sign this form, I cannot work with you. If I want to use or send, share or release your information for other purposes, I will discuss with you and ask you to sign an authorization form to allow this.

Disclosing your information without your consent

There are some times when the laws require me to use or share your information. For example:

1. Where there is a serious threat to your or another’s health and safety or to the public. I will only share information with persons who are able to help prevent or mitigate the threat.
2. When I am required to do so by legal or court proceedings.
3. If a law enforcement official requires me to do so.
4. For workers’ compensation and similar benefit programs, (eg. short/long-term disability). There are some other rare situations.

ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES

I have received a copy of the Notice of Privacy Practices. The Notice describes how any of your information may be used or disclosed. I understand that I should read it carefully. I am aware that the Notice may be changed at any time.

CONSENT FOR MINDSET COACHING AND/OR HYPNOTHERAPY

I do hereby seek and consent to participate in mindset coaching and/or hypnotherapy provided by the provider shown below.

I am aware that the practices of individual or group mindset coaching and/or hypnotherapy are not exact sciences and I acknowledge that no guarantees have been made to me as to the result of these procedures.

I am aware that my progress will be reviewed periodically.

I have received client orientation information which included the philosophy, policies and procedures for the private practice.

I am aware the records of my mindset coaching and/or hypnotherapy will be maintained and protected by the strictest standards of privacy and confidentiality.

I am aware that all services provided are covered by a Professional Liability Insurance Program endorsed by the American Board of Hypnotherapy.

My signature attests that I have been made aware of and agree with the fees and financial arrangement procedures.