CLIENT FORMS AND INFORMATION
Please do not send completed forms or any other confidential or sensitive information via e-mail, as it is not considered a secure form of communication and privacy cannot be guaranteed.
Click here for my HIPAA Notice of Privacy Practices.
Established clients: You can access my secure client portal here.
This is a release of information form parents can complete to consent to allow me to communicate with other professionals. The completed form can be uploaded via the secure portal linked above or printed out and brought to your next appointment..
New clients: When we schedule your first appointment following our initial phone consultation, I will send instructions for accessing my secure client portal where you can complete and submit the necessary intake forms.
Please check in with me regarding any questions. Thank you!
Patient Rights & Consumer Information
Accessing Your Health Records
You have the right to access your protected health information (medical and therapy records) in accordance with Texas and federal law. To request copies of your records, please contact us at:
* Phone: (512) 201-2995
* Email: maryellen@westfamilytherapy.com
* Mailing Address: 3724 Jefferson Street, Suite 207, Austin, TX 78731
Please allow a reasonable time for processing in compliance with applicable law.
Contacting the Licensing Authority
If you have questions about a licensed practitioner or need to reach the licensing authority, you may contact:
Texas Behavioral Health Executive Council
* Website: https://www.bhec.texas.gov/
* License verification and complaints: https://bhec.texas.gov/discipline-and-complaints/
Filing a Consumer Complaint
If you believe your rights have been violated or you wish to file a complaint, you may do so with the appropriate authority:
* Texas Behavioral Health Executive Council – Complaint information and forms are available at: https://www.bhec.texas.gov/
* Office of the Attorney General (Consumer Privacy Rights) – Additional resources regarding your privacy and health information rights can be found at: https://www.texasattorneygeneral.gov/consumer-protection/file-consumer-complaint/consumer-privacy-rights