TrueNorth Therapy – Patient Intake and Consent Agreement (For services provided by TrueNorth Inc. and TrueNorth NC PLLC)

Section 1: Agreement with TrueNorth Inc. (Platform Use & Payment Terms)

By accepting this agreement, I acknowledge and accept the following terms of use for the TrueNorth Therapy platform:

I understand that I am voluntarily accessing mental health services through TrueNorth Therapy.
I agree to create a secure account and provide accurate personal and contact information.
I understand that therapists set their own rates and that I am responsible for payment at the time of booking.
I agree to pay for each session out-of-pocket through the platform’s secure payment system.
I understand that cancellations must be made with at least 24 hours’ notice. Missed sessions or late cancellations may result in a full charge.
I understand that repeated no-shows may result in the suspension of my account.

Section 2: Consent to Telehealth Treatment (TrueNorth NC PLLC)

I voluntarily consent to receive mental health services via telehealth provided by licensed professionals affiliated with TrueNorth NC PLLC. I understand the following:

Telehealth includes the delivery of health care services using secure electronic communications (video, audio, or messaging).
I may experience disruptions or limitations due to technology.
I can withdraw my consent and discontinue services at any time.
I am responsible for maintaining privacy in my own environment during sessions.

Section 3: HIPAA Notice Acknowledgment

I acknowledge that I have received and reviewed the Notice of Privacy Practices from TrueNorth NC PLLC. I understand:

My personal health information is protected under HIPAA.
My provider may share information only as permitted by law (e.g., in cases of danger to self or others, suspected abuse, or legal requirements).
I have the right to access my records and request amendments in accordance with HIPAA regulations.

Section 4: Therapist-Specific Informed Consent

I understand that each therapist may have their own informed consent form. This may include:

Their specific treatment approach
Session frequency and expectations
Communication policies and boundaries
Risks, benefits, and alternatives to treatment

I agree to review and sign any additional therapist-specific informed consent form prior to beginning therapy, if required.

Governing Law

This agreement shall be governed by and construed in accordance with the laws of the State of North Carolina. Any legal action or proceeding related to this agreement shall be brought exclusively in the state or federal courts located in North Carolina.

Final Agreement

By checking the box and continuing, I confirm that I have read, understood, and agree to the terms in this agreement. I understand that this document governs both my use of the TrueNorth Therapy platform (TrueNorth Inc.) and my receipt of clinical care (TrueNorth NC PLLC).