Common use of Questions and Complaints Clause in Contracts

Questions and Complaints. If you have a concern or complaint about your treatment or about your billing statement, please talk to us about it. We will take your criticism seriously and respond respectfully. If you have questions about this notice, disagree with a decision we make about access to your records, or have other concerns about your privacy rights, you may contact us at 720.324-8781. If you believe that your privacy rights have been violated and wish to file a complaint with us, you may send your written complaint to: Xxxxx X. Xxxxxx, Ph.D. Enrich Relationship Center of Colorado 0000 Xxxx Xxxxxxx Xxxxxx, Xxxxx 000 Centennial, CO 80112 You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. We can provide you with the appropriate address upon request. You have specific rights under the Privacy Rule. We will not retaliate against you for exercising your right to file a complaint. We reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI that we maintain. A FINAL WORD The therapeutic relationship is a very personal and individualized partnership. We want to know what you find helpful and what, if anything, may be getting in the way. We want you to feel free to share with us what we can do to help. YOUR SIGNATURE BELOW INDICATES THAT YOU HAVE READ THIS AGREEMENT AND AGREE TO ITS TERMS AND SERVES AS AN ACKNOWLEDGEMENT THAT YOU HAVE RECEIVED THE HIPAA NOTICE DESCRIBED ABOVE. Signature: Date:

Questions and Complaints. If you have a concern or complaint about your treatment or about your billing statement, please talk to us about it. We will take your criticism seriously and respond respectfully. If you have questions about this notice, disagree with a decision we make about access to your records, or have other concerns about your privacy rights, you may contact us at 720.324-8781. If you believe that your privacy rights have been violated and wish to file a complaint with us, you may send your written complaint to: Xxxxx X. Xxxxxx, Ph.D. Ph.D., Enrich Relationship Center of Colorado Colorado, 0000 Xxxx Xxxxxxx Xxxxxx, Xxxxx 000 Centennial000, CO 80112 Xxxxxxxxxx, XX 00000. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. We can provide you with Services and the appropriate address upon requestBoard of Licensed Professional Counselors at 0000 Xxxxxxxx, Xxxxx 0000, Xxxxxx, XX 00000, 000-000-0000. You have specific rights under the Privacy Rule. We will not retaliate against you for exercising your right to file a complaint. We reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI that we maintain. A FINAL WORD The therapeutic relationship is a very personal and individualized partnership. We want to know what you find helpful and what, if anything, may be getting in the way. We want you to feel free to share with us what we can do to help. YOUR SIGNATURE BELOW INDICATES THAT YOU HAVE READ THIS AGREEMENT AND AGREE TO ITS TERMS AND SERVES AS AN ACKNOWLEDGEMENT THAT YOU HAVE RECEIVED THE HIPAA NOTICE DESCRIBED ABOVE. Client Signature: Date:

Questions and Complaints. If you have a concern or complaint about your treatment or about your billing statement, please talk to us about it. We will take your criticism seriously and respond respectfully. If you have questions about this notice, disagree with a decision we make about access to your records, or have other concerns about your privacy rights, you may contact us at 720.324-8781. If you believe that your privacy rights have been violated and wish to file a complaint with us, you may send your written complaint to: Xxxxx X. Xxxxxx, Ph.D. Ph.D., Enrich Relationship Center of Colorado Colorado, 0000 Xxxx Xxxxxxx Xxxxxx, Xxxxx 000 Centennial000, CO 80112 Xxxxxxxxxx, XX 00000. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. We can provide you with Services and the appropriate address upon requestBoard of Psychology at 0000 Xxxxxxxx, Xxxxx 0000, Xxxxxx, XX 00000, 000-000-0000. You have specific rights under the Privacy Rule. We will not retaliate against you for exercising your right to file a complaint. We reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI that we maintain. A FINAL WORD The therapeutic relationship is a very personal and individualized partnership. We want to know what you find helpful and what, if anything, may be getting in the way. We want you to feel free to share with us what we can do to help. YOUR SIGNATURE BELOW INDICATES THAT YOU HAVE READ THIS AGREEMENT AND AGREE TO ITS TERMS AND SERVES AS AN ACKNOWLEDGEMENT THAT YOU HAVE RECEIVED THE HIPAA NOTICE DESCRIBED ABOVE. Client Signature: Date:

Questions and Complaints. If you have a concern or complaint about your treatment or about your billing statement, please talk to us about it. We will take your criticism seriously and respond respectfully. If you have questions about this notice, disagree with a decision we make about access to your records, or have other concerns about your privacy rights, you may contact us at 720.324-8781. If you believe that your privacy rights have been violated and wish to file file a complaint with us, you may send your written complaint to: Xxxxx X. Xxxxxx, Ph.D. Enrich Relationship Center of Colorado 0000 Xxxx Xxxxxxx Xxxxxx, Xxxxx 000 Centennial, CO 80112 You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. We can provide you with the appropriate address upon request. You have specific specific rights under the Privacy Rule. We will not retaliate against you for exercising your right to file file a complaint. We reserve the right to change the terms of this notice and to make the new notice provisions effective effective for all PHI that we maintain. A FINAL WORD The therapeutic relationship is a very personal and individualized partnership. We want to know what you find find helpful and what, if anything, may be getting gegng in the way. We want you to feel free to share with us what we can do to help. YOUR SIGNATURE BELOW INDICATES THAT YOU HAVE READ THIS AGREEMENT AND AGREE TO ITS TERMS AND SERVES AS AN ACKNOWLEDGEMENT THAT YOU HAVE RECEIVED THE HIPAA NOTICE DESCRIBED ABOVE. Signature: Date: