Treatment Consent

Important. The information on this page is published for general educational purposes only and is not a substitute for, and does not replace, the formal Treatment Consent that your treating clinician will review and sign with you at intake. Reading this page does not, by itself, create a clinician-patient relationship with Pasadena Clinical Group ("the Practice"). A treatment relationship begins only after intake, completion of all required forms, and the clinician's express, written acceptance of you as a patient. Until then, no information shared on this Site is intended to diagnose, advise, or treat any condition. The controlling document is the executed consent you sign at intake, which supersedes anything inconsistent on this page.

1. Information only — not a self-diagnosis tool

Nothing on this Site, in any blog post, condition page, FAQ, video, screening tool, or other resource, is a substitute for evaluation, diagnosis, or treatment by a California-licensed clinician. The Site is published for educational purposes and shall never be used by you to (a) self-diagnose, (b) determine the presence, absence, course, or severity of any condition, or (c) make decisions about whether to start, stop, modify, or delay any treatment, medication, supplement, or therapy. Self-diagnosis is dangerous and is not the purpose of any content on this Site. You agree to consult a qualified, licensed clinician before relying on any information you read here.

2. Voluntary participation and right to terminate

Psychotherapy is voluntary. You may withdraw from treatment at any time and for any reason. We ask that, where possible, you discuss any decision to terminate with your clinician so that we can support your transition to other resources, wrap up the work appropriately, and arrange referrals if needed. Termination, like all clinical decisions, is yours to make. The Practice may also terminate the therapeutic relationship for clinical, ethical, safety, or administrative reasons (including but not limited to non-payment, non-attendance, threats to staff, fraud, conflicts of interest, or your needs exceeding our scope of practice), with reasonable notice and referrals.

3. Risks, limitations, and benefits of psychotherapy — no guarantee of outcome

Psychotherapy can produce meaningful benefits — including reduction of symptoms, improved relationships, increased self-understanding, and behavior change. It can also involve discomfort. Risks may include experiencing strong emotions, recalling unpleasant memories, temporary worsening of symptoms before improvement, conflict in relationships as you change, dissatisfaction with progress or pace, and disagreement with your clinician's recommendations. Some clients experience little or no improvement. There are no guarantees, express or implied, of any particular result, outcome, recovery, diagnosis, prognosis, recovery time, or "cure" of any condition. Outcomes depend on many factors, including your engagement, life circumstances, and the appropriateness of the therapeutic approach for your situation. If at any point you feel that the therapy is not a fit or is not helping, please raise it with your clinician — we welcome the conversation and will discuss alternatives or referrals.

4. Scope of services — outpatient only

The Practice is an outpatient mental-health practice. We do not, and the Site does not, provide: (a) emergency, crisis, or after-hours services; (b) inpatient or residential care; (c) medical, psychiatric, prescribing, or medication-management services (your clinician may, in clinical judgment, recommend referral to a medical provider for medication evaluation); (d) custody evaluations, forensic evaluations, fitness-for-duty evaluations, immigration evaluations, or expert testimony except as separately contracted; or (e) services to anyone outside California (clinicians' California licensure does not extend across state lines for telehealth). If you are experiencing an emergency, do not contact the Practice through the Site. Call 911, go to your nearest emergency department, or call/text 988.

5. Confidentiality and its mandatory limits under California and federal law

The information you share is generally confidential and protected by, among other authorities, the federal psychotherapist-patient privilege (Jaffee v. Redmond, 518 U.S. 1 (1996)), the California psychotherapist-patient privilege (Cal. Evid. Code §§1010–1027), HIPAA (45 C.F.R. Parts 160–164), the California Confidentiality of Medical Information Act (CMIA, Cal. Civ. Code §56 et seq.), and the Lanterman-Petris-Short Act (Welf. & Inst. Code §5328 et seq.). However, the law requires us to disclose certain information without your authorization. Mandatory exceptions include:

• Suspected child abuse or neglect — under the California Child Abuse and Neglect Reporting Act (CANRA, Cal. Penal Code §11164 et seq.), our clinicians are mandated reporters and must report.
• Suspected elder or dependent-adult abuse — Welf. & Inst. Code §15630.
• Communicated threat of serious physical violence against an identifiable victim — under the so-called Tarasoff duty (Cal. Civ. Code §43.92, codifying Tarasoff v. Regents of the University of California, 17 Cal. 3d 425 (1976), as modified by Ewing v. Goldstein, 120 Cal. App. 4th 807 (2004)), we must take reasonable steps to protect the intended victim, which may include warning the victim and/or law enforcement.
• Imminent danger to self or others — including risk of suicide, serious self-harm, or grave disability — we may take steps reasonably necessary to protect you or another person, including disclosing information to emergency services, crisis teams, or designated emergency contacts, and we may initiate or facilitate evaluation under Welf. & Inst. Code §5150.
• Court orders, subpoenas, and warrants — we will, where permissible, notify you, assert applicable privileges, limit disclosure to the minimum necessary, and seek your input on the response.
• Other mandated reports — including communicable-disease reporting and any other reporting required by law.

You agree that the Practice and its clinicians, employees, contractors, students, trainees, and volunteers shall not be liable for making any disclosure required by law, in good faith, or to protect any person's safety, and you waive any claim arising from such a disclosure to the maximum extent permitted by law (Cal. Civ. Code §43.92(b) provides immunity for clinicians complying with the Tarasoff duty).

6. Group-therapy confidentiality — limits and your obligations

If you participate in group therapy, additional confidentiality rules apply:

• Every group member must sign a written confidentiality agreement at intake, agreeing not to disclose the identity of other members or the content of group discussions outside group.
• The Practice cannot legally guarantee the confidentiality conduct of every group member. While breach of the agreement may have legal consequences, it cannot be undone, and we make no warranty against breach.
• You agree to disclose only what you are comfortable disclosing, to refrain from any unauthorized recording, and to honor the confidentiality of fellow members.
• The clinical limits to confidentiality (mandated reporting, Tarasoff, imminent danger, court orders) apply to group as they do to individual therapy.

7. Insurance, payment, and disclosures to payers

If you use insurance, your insurer or third-party administrator may receive billing information, including diagnostic codes (DSM-5/ICD-10), dates and durations of service, and procedure (CPT) codes. Session content is not disclosed. Submitting a claim is itself a disclosure that creates a record with your insurer that may affect future coverage decisions, underwriting, or recordkeeping. You may pay in full out of pocket and direct that the Practice not disclose the related PHI to a health plan (Cal. Civ. Code §56.107). Psychotherapy notes (process notes) are kept separately and disclosed only with your written authorization. See No Surprises Act / Good Faith Estimate for self-pay disclosures.

8. Communication outside session

Email, text, and voicemail are convenient but not fully secure. With your express consent (documented at intake), we may use these channels for scheduling and brief logistics. Please do not send clinical content, sensitive material, or content reasonably expected to be confidential through unsecured channels; if you do, you assume the risks of those channels. We respond to non-urgent communication within one to two (1–2) business days. We do not provide clinical care, advice, or crisis intervention by email, text, voicemail, or social media; do not contact us through these channels in an emergency.

9. Recording prohibition

You agree that you will not record, audio or video, any session — in person or via telehealth — without the prior written consent of every participant. California is a two-party-consent jurisdiction (Cal. Penal Code §632); recording without consent may violate state and federal law and may be the basis for civil and criminal liability. The Practice does not record sessions.

10. Records and retention

California law generally requires that adult psychotherapy records be retained for at least seven (7) years from the date of last service (Cal. Code of Regulations Title 16; Bus. & Prof. Code provisions applicable to mental-health practices). Records of minors are retained until one (1) year past the patient's age of majority or seven (7) years from last service, whichever is later. Records may be destroyed thereafter unless a legal hold applies. You have rights to inspect, copy, and amend your records as described in our Notice of Privacy Practices.

11. Minors and consent (where applicable)

California Family Code §6924 allows minors twelve (12) and older to consent to outpatient mental-health treatment under certain conditions, including when the minor is mature enough to participate intelligently in the treatment and the situation involves a danger of serious physical or mental harm to the minor or others, or the minor is the alleged victim of incest or child abuse. Where a minor consents under §6924, the minor controls confidentiality with respect to the parent or guardian, subject to clinical and legal limits. Where parental consent is required, the Practice will discuss with both the minor and the parent or guardian the framework of confidentiality at intake. Cal. Health & Safety Code §123115 may permit a clinician, in professional judgment, to limit a parent's access to records when access would create a substantial risk of detrimental effect on the minor's physical safety or psychological well-being.

12. Dual relationships, social media, and clinician boundaries

To preserve the integrity of treatment, our clinicians do not enter into dual relationships with current or former clients, do not accept friend or follow requests on social media, and do not engage with you outside the therapeutic frame except as clinically indicated. This is a clinical and ethical boundary, not a personal one, and is for your protection.

13. Professional liability and scope

The Practice's clinicians provide services within the scope of their California licenses. Psychotherapy is an inexact discipline; differences of professional opinion among clinicians are common. To the maximum extent permitted by law, you agree that the Practice, its owners, employees, independent contractors, students, trainees, interns, practicum students, externs, postdoctoral fellows, and volunteers are not liable for any indirect, incidental, special, consequential, or punitive damages arising from the therapeutic relationship, except where such limitation is prohibited by law or is the result of fraud, gross negligence, or willful misconduct (Cal. Civ. Code §1668). Nothing in this section limits any non-waivable right you may have under California law as a consumer of mental-health services.

14. Acknowledgement and assumption of risk

By engaging in psychotherapy with the Practice, you acknowledge that (a) you have had the opportunity to ask questions and have your questions answered; (b) you understand the limits of confidentiality and the mandatory exceptions; (c) you understand the risks, benefits, and limitations of psychotherapy and that no specific outcome is guaranteed; (d) you assume the inherent risks of engaging in therapy as described above; (e) you agree that the Site's content is informational only and not a substitute for individualized clinical judgment; and (f) you release and hold harmless the Practice, its personnel, and its volunteers from any claim arising from a good-faith disclosure required or permitted by law.

15. Dispute resolution — mediation, then binding arbitration; jury waiver

Subject to non-waivable rights you may have under California or federal law, you agree that any non-clinical dispute relating to the Practice's services, billing, or website (a "Dispute") shall be resolved as set forth in the Terms & Conditions: first by good-faith mediation administered by JAMS in Los Angeles County, California, and, if mediation does not resolve the Dispute within sixty (60) days, by final and binding individual arbitration administered by JAMS in Los Angeles County under the JAMS Comprehensive (or, where applicable, Streamlined) Arbitration Rules, governed by the Federal Arbitration Act and California substantive law. The parties knowingly and voluntarily waive any right to a jury trial and to participate in class or representative proceedings, except to the extent such waiver is unenforceable under controlling law. Disputes arising specifically out of clinical care that fall under any state or federal mental-health-malpractice or peer-review process shall be addressed pursuant to the procedures applicable to such disputes (including, where relevant, Cal. Code of Civil Procedure §1295), but the foregoing mediation step shall apply to the maximum extent permitted by law.

16. Cancellations and fees

See Office Policies for the current cancellation policy and fee schedule. Late-cancellation and no-show fees are not covered by insurance.

Contact us about this page

Questions, requests, or complaints regarding this Treatment Consent or your care can be directed to our Privacy Officer, Pasadena Clinical Group, 301 N. Lake Ave, STE 600, Pasadena, CA 91101, by phone at (626) 354-6440, or by email at office@pasadenaclinicalgroup.com.