Comprehensive Legal Agreement & Privacy Practices

Cuyahoga Valley Mindful Health & Wellness LLC

Client Services Agreement

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1. Introduction

This Client Services Agreement ("Agreement") is entered into between Cuyahoga Valley Mindful Health & Wellness LLC ("the Company," or "CVMHW,") and the individual receiving services ("the Client"). By engaging in any services provided by the Company, the Client acknowledges and agrees to be bound by the terms and conditions set forth herein. This Agreement is designed to ensure clarity, compliance with applicable laws, and protection of both parties’ rights and responsibilities.

2. Definitions

For the purposes of this Agreement, the following terms shall have the meanings set forth below:

• "Body Members": Individuals directly engaged in Company operations, including but not limited to licensed counselors, life coaches, athletic coaches, administrative staff, legal consultants, accountants, billing consultants, insurance affiliates, debt collectors, and board members, as defined under Ohio Rev. Code § 4757.01 where applicable.

• "Client": Any individual who enters into this Agreement to receive psychotherapy, life coaching, or athletic coaching services from the Company.

• "Consultation Services": Non-medical, non-psychological services, specifically life coaching and athletic coaching, which do not involve diagnosis or treatment of medical or mental health conditions under state or federal law.

• "Good Faith Estimate": A written estimate of anticipated service costs provided to the Client within 1-3 business days of scheduling, pursuant to the No Surprises Act (42 U.S.C. § 300gg-19a).

• "Household Income": The aggregate gross income of all members of the Client’s household, as reported in the most recent federal tax return, used to determine eligibility for sliding fee scales or pro-bono services.

• "Medical Services": Psychotherapy services involving the diagnosis, treatment, or management of mental health conditions, provided by licensed professionals under clinical supervision, compliant with HIPAA (42 U.S.C. § 1320d et seq.) and Ohio Rev. Code § 4757.

• "Protected Health Information (PHI)": Any information relating to the Client’s past, present, or future physical or mental health, healthcare provision, or payment, as defined under HIPAA (45 C.F.R. § 160.103).

• "Services Rendered": Activities related to consultation, athletic or life coaching, or medical services, including the provision of intellectual property or Company materials, with or without payment.

3. Services Offered

3.1 Psychotherapy Services

3.1.1 Scope and Supervision
The Company provides psychotherapy services for individuals, families, and couples, addressing conditions such as anxiety, depression, trauma, autism spectrum disorders, and relational conflicts. These services are rendered by Eric Riesterer, Licensed Professional Counselor (LPC), under the supervision of Wendy Nathan, Licensed Professional Clinical Counselor with Supervision Designation (LPCC-S), in compliance with Ohio Rev. Code § 4757.

• Therapeutic Process: Sessions are typically 50-60 minutes, scheduled collaboratively, utilizing evidence-based interventions. Progress is reviewed periodically with formal treatment plan reviews every 6 months and biopsychosocial assessment updates once per calendar year.

• Regulatory Compliance: Services adhere to HIPAA (45 C.F.R. Parts 160 and 164), ensuring PHI confidentiality and security.

• Informed Consent: Clients must sign an informed consent form prior to treatment, outlining scope, risks (e.g., emotional distress), benefits (e.g., symptom relief), and rights under Ohio law.

3.1.2 Referrals and Level-of-Care Adjustments
If outpatient psychotherapy is insufficient, the Company will facilitate referrals to higher levels of care (e.g., intensive outpatient programs, inpatient facilities, or psychiatric care). Clients may resume outpatient services upon stabilization.

3.1.3 Crisis Management
In mental health emergencies, Clients should contact 911 or visit an emergency room. The Company provides outpatient psychotherapy clinical mental health counseling services under supervision as well as consultation services and is not equipped for crisis intervention within this level-of-care.

3.2 Life Coaching Services

3.2.1 Scope and Limitations
Life coaching is a non-clinical consultation service focused on personal growth, goal-setting, stress management, and life transitions. It is not a medical or psychological service and does not involve diagnosis or treatment per DSM-V-TR or ICD-11.

• Methodology: Sessions are action-oriented, potentially including homework and accountability measures, using techniques like motivational interviewing.

• Session Format: Available in-person, via phone, or video conferencing, including walk-and-talk options.

• Service Exclusivity: Clients cannot receive life coaching and psychotherapy concurrently from the Company. Transition to psychotherapy is permitted following a clinical assessment if needed.

• Non-Medical Disclaimer: Coaches do not provide medical or psychological care. Clients should consult licensed professionals for health concerns.

3.2.2 Medical Emergencies
Life coaching is not a substitute for medical or mental health care. Clients experiencing emergencies should seek immediate professional assistance.

3.3 Athletic Coaching Services

3.3.1 Scope and Limitations
Athletic coaching offers customized scholarly and evidenced-based training plans for runners and athletes, integrating methodologies like Dr. Jack Daniels’ VDOT, Dr. Thomas Schwartz’s "Tinman," Dr. Jay Johnson’s, and Tony Holler’s "Feed the Cats." It is a consultation service, not a medical or psychological intervention.

• Programs:

  • Free introductory consultation

  • Couch to 5K (16 weeks)

  • First Marathon (26 weeks)

  • Endurance Athletic Development (52 weeks)

  • Sprint/Middle-Distance/Distance Camps (12-20 weeks)

  • Race Plan Consultation (1 hour)

• Initial Assessment: Required to evaluate fitness and goals.

• Non-Medical Nature: Coaches do not diagnose or treat conditions. Clients assume health-related risks and must disclose limitations.

3.3.2 Health and Safety
Clients with pre-existing conditions must obtain medical clearance. The Company recommends regular health check-ups during training.

3.3.3 Virtual Consultations
Available via video conferencing to discuss plans and progress, not replacing medical evaluations via HIPAA-Compliant Doxy.me.

3.4 Telehealth Services

Psychotherapy, Life Coaching and Athletic Coaching Services, Consultation Services may be offered via secure, HIPAA-compliant platform Doxy.me (psychotherapy.) Clients must ensure privacy during sessions.

3.5 Services for Minors

Parental or guardian consent is required for Clients under 18. Parents may participate in family therapy or sign liability waivers for athletic coaching.

4. Fees and Payment

4.1 Standard Fees

• Psychotherapy:

  • Standard Session (1 hour): $120

  • Parent Session (without patient): $100

  • Biopsychosocial Assessment: $150

• Life Coaching: $45/hour

• Athletic Coaching:

  • Couch to 5K: $250

  • First Marathon: $350

  • Endurance Athletic Development: $850

  • Camps: $300-$400

  • Race Plan Consultation: $45

Payment is due at the time of service unless a payment plan is arranged.

4.2 Insurance

Psychotherapy accepts Aetna, Anthem BCBS, Beacon Health, Carelon, Cigna, Frontpath, Medical Mutual, Molina, OptumHealth, Paramount, United Healthcare, Medicare, and Medicaid. Clients must verify coverage and are responsible for co-pays or balances. Life coaching and athletic coaching are not insurance-eligible.

4.3 Sliding Fee Scales

• Psychotherapy: $45-$70/hour

• Life Coaching: $25-$45/hour

• Athletic Coaching: 10-20% discount
  Eligibility requires submission of the most recent tax return or equivalent documentation, ensuring compliance with nondiscrimination laws (e.g., 42 U.S.C. § 18116).

4.4 Pro-Bono Services

Available for severe financial hardship (e.g., unemployment, medical necessity), subject to availability. Clients must submit a written application with supporting documentation (e.g., proof of income loss).

4.5 Payment Plans

Clients may request a payment plan by submitting a written request and financial documentation. If approved, a notarized agreement will outline terms with Legal Counsel and Accounting Services.

4.6 Refunds

• Athletic Coaching: Full refund within 4 weeks; partial (less 10% fee) thereafter with documented hardship.

• Psychotherapy and Life Coaching: Refundable after service delivery on a case-by-case basis based on professional fit within first 3 months of initial intake assessment (psychotherapy) or initial consult (life coaching consultation services) determined by level-of-care change needs, lacking fit between the Company and Client, and/or sub-standard improvements for consultation service, mental health service, comprehensive wellness service, diagnostic and/or treatment plan consideration. Refunds must be approved by Client, Provider/Consultant and Patient Rights Officer.
  Unpaid balances may be referred to third-party collectors with non-PHI data disclosed per privacy policies.

5. Good Faith Estimates

The Company provides a Good Faith Estimate of anticipated costs within 1-3 business days of scheduling, per the No Surprises Act, to promote transparency.

6. Confidentiality and Privacy

6.1 Psychotherapy

• HIPAA Compliance: PHI is protected via secure systems, Theranest, with access limited to authorized personnel trained in HIPAA compliance. Telehealth Platform is HIPAA Compliant with PHI Encryption when using Chat Function via Doxy.me. Telehealth PHI Data is not retained or stored with the Company outside of standard documentation practices.

• Exceptions: Confidentiality is maintained except for mandated reporting (Ohio Rev. Code § 2151.421, § 5101.63) or imminent harm risks.

6.2 Life Coaching and Athletic Coaching

• Limited Confidentiality: Privacy is maintained where feasible, but sessions in public settings lack HIPAA protections.

• Mandated Reporting: Professionals must report suspected abuse, neglect, or imminent threats under Ohio law.

6.3 Data Security

Electronic health records for psychotherapy are HIPAA-compliant via Theranest. Life coaching and athletic coaching data use encrypted channels and secure storage, though not HIPAA-regulated.

6.4 Record Retention

• Psychotherapy: Retained for 7 years post-service per Ohio law.

• Life Coaching and Athletic Coaching: Retained for 2 years post-service.

7. Client Rights and Responsibilities

7.1 Client Rights

• Receive respectful, nondiscriminatory treatment (42 U.S.C. § 18116).

• Submit grievances to Wendy Nathan, LPCC-S (419-377-3057, WNathanWellness@gmail.com), with a response within 5 business days.

• Access and copy psychotherapy records (copying fee: $25).

• Request amendments to records (reviewed within 30 days).

• File privacy complaints with the Company or U.S. Department of Health and Human Services without retaliation.

7.2 Client Responsibilities

• Provide accurate information.

• Adhere to payment terms.

• Disclose health concerns (athletic coaching).

8. Liability and Disclaimers

The Company is not liable for injuries, damages, or losses from consultation services or Client failure to seek medical advice. Life coaching and athletic coaching are not medical services, and no specific outcomes are guaranteed.

9. Intellectual Property

All materials, including training plans and consultation content, are proprietary to the Company, protected under 17 U.S.C. §§ 101-1332. Unauthorized use may result in legal action.

10. Termination of Services

Either party may terminate services with written notice. The Company may terminate for non-payment, inappropriate behavior, or if services are no longer suitable.

11. Governing Law and Dispute Resolution

This Agreement is governed by Ohio law. Disputes shall be resolved via mediation or arbitration in Ohio.

12. Compliance with Laws

The Company complies with:

• Section 1557 of the Affordable Care Act (42 U.S.C. § 18116) & Final Rule 2024 Revisions

• No Surprises Act with Good-Faith Estimates

• Ohio Rev. Code § 4757 for Professional Supervision under the LCSWMFT Board

• Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d)

• Age Discrimination Act of 1975 (42 U.S.C. §§ 6101-6107)

• Americans with Disabilities Act (42 U.S.C. §§ 12101 et seq.)

13. Provider Qualifications

• Psychotherapy: Mental Health Counselor, DEC2020-Present: Eric Riesterer, LPC, Supervision: Wendy Nathan, LPCC-S.

• License: Riesterer, Eric M., C.2103177, 2/9/2025-2/8/2027

• Scope of Practice (Under-Supervision): Anxiety, Depression, Bipolar Disorder, PTSD, Autism (Mild/Moderate), Trauma Counseling, Logotherapy, Faith-Based Counseling, Cognitive-Processing Therapy (CPT), Mindfulness-Based CBT (M-CBT), Play Therapy, Family Counseling, Military Issues, Classical & Operant Psychology, Boy's & Men's Issues, Adjustment Disorders, Substance Abuse Counseling, Gambling Disorder, Crisis Referral.

• Advanced Training Licensure: Play Therapy, 30hrs Structured Development Continuing Education Course, Child Developmental Psychology & Mental Health Counseling Interventions Ages 4-17

• Academic Research Emphasis: Trauma Counseling and PTSD, Suicide Contagion (Werther Effect) during COVID19 Pandemic (DEC19-MAY20) in Stark County, OH, Grades 6-8.

• Athletic Coaching: OHSAA-licensed & registered coaching with NCAA DII and elite post-collegiate experience, Pupil Activity Permit (Active), CPR, Concussion, and First Aid certified.

14. Entire Agreement

This Agreement constitutes the full understanding between the Company and Client, superseding prior agreements.

15. Amendments

The Company may amend this Agreement, notifying Clients of changes. Continued service use constitutes acceptance.

16. Acceptance

By engaging in Company services, the Client acknowledges reading, understanding, and agreeing to this Agreement.