EVA GREGORY COUNSELING ON LINE - COMPLETE PROBATION CONDITIONS AND SAVE TIME AND MONEY.
Gregory Counseling Privacy Act and Policies & Procedures
 
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy regulations implemented standareds for how information that identifies a patient can be used and disclosed. (Title 45, Code of Federal Regulations (CFR), PARTS 160 AND 164. the "covered entities" including health-care plans, health-care clearinghouses, and health-care providers.  These privacy standards went into effect on April 14, 2003.
 
This is to inform you that  the privacy Act will be enforced by Gregory Counseling except if you are on Probation or in Pre-Trail.  The Criminal Justice System has access to  your personal files without your written consent. Your attorney, court coordinator, Judge and Probation Officer can see your file without your written consent.
 
Also, if our counselors are aware that you are abusing a child, committing a crime, or may be a danger to yourself or another person, the proper authorities will be notified.
 
Otherwise, your written consent must be secured before any information about you can be released.  You have a right to make an appointment and view your file with Mrs. Gregory.
 
CONSUMER FRAUD:  Using a debit or credit card without funds or without authorization will be turned over to the District Attorney and Probation will be notified immediately.  You will be prosecuted for the crime.
 
REFUND POLICY:  There will be no refunds on any class. WE ARE A SERVICE COMPANY. YOU CANNOT DEBATE A PAYMENT.  YOUR CREDIT CARD COMPANY ONCE YOU SUBMIT PAYMENT, IT IS FINAL.  IF YOU ARE IN QUESTION ABOUT TAKING THE CLASS, CALL THE COUNSELOR FIRST AND FIND OUT AN ANSWER TO YOUR CONCERNS.    Contact Mrs. Gregory for a sample class before starting and paying your fee.  If your computer crashes, FIRST STEP Counseling will print off the course material and mail it to you for completion.  There will be an extra charge of $15.00.  OUR STAFF ALSO WILL GIVE YOU THE TEST ORAL BY PHONE.
 
CO-PAYMENT FOR IN OFFICE SESSION:  In addition to base online fee, a co-payment of $17.00 for each in office session will be required.
 
I HAVE READ THE ABOVE AND UNDERSTAND THE PRIVACY ACT, POLICIES AND PROCEDURES AT GREGORY COUNSELING.
Client Electronic Signature
Date Signed
FIRST AND LAST NAME;
MAILING ADDRESS INCLUDING ZIP CODE
CURRENT CONTACT PHONE NO. (CELL PHONE)
CURRENT E-MAIL ADDRESS;
PROBATION OFFICER'S NAME:
PROBATION OFFICER'S FAX NO.
YOUR SPN#
YOUR CAUSE NO.
YOUR DATE OF BIRTH
 
 
 
 
 
 
 
 
 
 
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