Your rights, our commitments, our policies

Your health information is protected under the Health Insurance Portability and Accountability Act (HIPAA). As your healthcare provider, we are required by law to: • Maintain the privacy of your protected health information (PHI) • Provide you with notice of our legal duties and privacy practices • Follow the terms of our notice currently in effect Uses and Disclosures for Treatment: We may use and share your health information to provide and coordinate your care among treating providers. Uses and Disclosures for Payment: We may use and disclose your health information to obtain payment from your health insurer or other payer. Uses and Disclosures for Healthcare Operations: We may use and disclose your health information in connection with our healthcare operations, including quality assessment, training, and business management. Disclosures Required by Law: We will disclose your health information when required by law, including reporting of child abuse or neglect, imminent danger to self or others, or when ordered by a court. Your Rights: You have the right to request restrictions on certain uses of your PHI, to receive a copy of your records, to request corrections to your records, and to file a complaint if you believe your privacy rights have been violated. To file a complaint: Contact our Privacy Officer at the clinic address, or contact the U.S. Department of Health and Human Services Office for Civil Rights at 1-800-368-1019.

Before beginning services, all clients review and sign an Informed Consent for Treatment. This document covers: Scope of Services: Dr. Paula Gable provides licensed marriage and family therapy (LMFT) and addiction counseling (LAC) services. These are clinical, licensed services subject to Colorado professional standards. Voluntary Participation: Participation in therapy is voluntary. You may discontinue services at any time by notifying your therapist. Confidentiality: Your sessions are confidential, subject to exceptions required by law (mandatory reporting, court orders, and imminent danger situations). Telehealth Specifics: When using telehealth, you consent to video session delivery and acknowledge the inherent limitations of remote care including technology disruptions. Risks and Benefits: Therapy can produce positive change but may also involve discomfort as difficult topics are addressed. There is no guarantee of specific outcomes. Emergency Protocol: In a mental health emergency, call 988 (Suicide & Crisis Lifeline) or 911. Your therapist is not available 24/7 for crisis response. Copies of your signed consent form are available upon request at any time.

We ask for at least 24 hours notice for all cancellations or reschedules. Late Cancellations: Cancellations made with less than 24 hours notice may be charged a late cancellation fee equivalent to your session co-pay or self-pay rate. This fee is not billable to insurance. No-Shows: Clients who do not attend their scheduled session without prior notice will be charged the full session rate. This fee is not billable to insurance. Emergencies: We understand that genuine emergencies occur. Late cancellation and no-show fees may be waived at our discretion for documented emergencies or medical crises. Repeated Cancellations: Clients who cancel or no-show more than three times in a 90-day period may be asked to schedule less frequently or transition to a different care arrangement. How to Cancel: Call our office at 303-357-9743, or use the client portal link sent with your appointment confirmation. Email is not monitored for same-day cancellations.

Insurance Billing: We accept Medicare, Medicaid (Health First Colorado), Aetna, Cigna, BlueCross BlueShield, United Health, and Anthem. Our team verifies your benefits before your first session and informs you of any co-pay or deductible responsibility. Self-Pay Rates: Self-pay session rates are available on request. A sliding scale is available based on household income and family size — no one is turned away due to inability to pay. Payment Timing: Co-pays and self-pay fees are collected at the time of service. We accept credit card, debit card, HSA, and FSA payment. Superbills: If we do not bill your insurer directly, we can provide a monthly superbill (itemized receipt) for you to submit to your insurance for potential reimbursement. Outstanding Balances: Accounts with balances more than 60 days past due may result in a pause of services until the balance is resolved. Payment plans are available — please speak with our billing team. Billing Questions: Contact our billing team at 303-357-9743 or billing@mfi.ngo.

The Marriage and Family Institute is committed to providing care that is free from discrimination. We do not discriminate on the basis of: • Race, color, or national origin • Sex, gender identity, or sexual orientation • Age or disability • Religion or spiritual tradition • Socioeconomic status or insurance type • Immigration status or language LGBTQ+ Affirming: Dr. Paula Gable and all MFI clinicians are LGBTQ+ affirming. We welcome clients of all gender identities, sexual orientations, and relationship structures. Language Access: We offer services in English and conversational Spanish. Interpreter services may be arranged for other languages with advance notice. ADA Accommodations: Reasonable accommodations are available for clients with disabilities. Please notify us in advance of any accommodation needs. Civil Rights: If you believe you have experienced discrimination in violation of civil rights laws, you may file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights at ocrportal.hhs.gov.

When receiving services via telehealth, you acknowledge and agree to the following: Technology: Sessions are conducted via a HIPAA-compliant, encrypted video platform. No software installation is required — you receive a secure link before each session. Your Responsibilities: You agree to participate in sessions from a private location where you cannot be overheard, with a stable internet connection, using a device with a working camera and microphone. Recording: Sessions are not recorded by MFI without explicit written consent. You agree not to record sessions without informing your therapist. Technical Disruptions: In the event of a technology failure during a session, your therapist will attempt to reconnect via video. If reconnection is not possible, the session may continue via telephone or be rescheduled without charge. Location and Licensing: Telehealth services are provided to Colorado residents only. You confirm that you are physically located in the state of Colorado at the time of each session. Emergency Protocol: If a crisis occurs during a telehealth session, your therapist will facilitate contact with local emergency services. Please have the address of your physical location accessible during sessions.