Notice of Privacy Practices

Counseling4Change, LLC · Arthur H. Belmont, LMFT · Oct 14, 2026

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Effective date: October 14, 2026

This notice applies to Counseling4Change, LLC and Arthur H. Belmont, LMFT ("we," "us," "our"), who provide psychotherapy and related services by telehealth. It explains how we may use and share your health information, what rights you have over it, and how to reach us with questions or complaints.

"Protected health information" (PHI) means information that identifies you and relates to your mental or physical health, your care, or payment for your care, whether spoken, written, or electronic.

Privacy contact: Arthur H. Belmont, LMFT, Privacy Officer · +1 (888) 787-1767 · Arthur.Belmont3@pm.me · 1317 Edgewater Drive, Suite #4546, Orlando, FL 32804-6350

Our responsibilities

We are required by law to keep your PHI private and secure, to give you this notice, and to follow the terms of the notice currently in effect. We will:

Tell you promptly if a breach occurs that may have compromised the privacy or security of your information.
Use or share your PHI only as described in this notice, unless you give us written permission. You may take that permission back at any time by telling us in writing.
Make this notice available on our website and give you a copy on request, including at your first session.

We may change this notice and the changes will apply to all PHI we already hold. See "Changes to this notice" below.

How we may use and share your information for treatment, payment, and operations

Federal law lets us use and share your PHI for these three purposes without a separate written authorization. Mental health information often has stronger protection under state law (California, Florida, Michigan, and Texas each have their own rules). Where state law is stricter, we follow it, which often means asking for your written permission before we share mental health information with another provider.

Treatment. We use your information to provide and coordinate your care. Example: with your permission, we may speak with your psychiatrist or primary care physician so your treatment plans fit together, or consult another clinician about your care.

Payment. We use your information to bill for services and collect payment. Example: we may give your health plan your name, diagnosis, dates of service, and the type of session so it can pay a claim or confirm your coverage, or give you a receipt ("superbill") to submit yourself.

Health care operations. We use your information to run and improve our practice. Example: we may review records for quality and training, receive clinical supervision or peer consultation, or use accounting, legal, scheduling, billing, or technology services that must also protect your information under a written agreement with us.

Other communications. We may contact you to remind you of appointments, using the phone number, email, or text number you gave us and the way you ask us to reach you. We may also tell you about treatment options or health-related services that may interest you.

When we need your written authorization

We will ask for your written authorization before we use or share your PHI in any way not described in this notice. You may revoke an authorization at any time, in writing. Revoking it stops future uses but does not undo disclosures already made in reliance on it. In particular, we need your authorization for:

Psychotherapy notes. These are a therapist's private notes about the content of sessions, kept separate from your clinical record. We use them only as you authorize, except where the law allows: for our own treatment of you, for our own training programs, to defend ourselves in a legal action you bring, when required by law, for oversight of us by a health authority, to prevent a serious threat to health or safety, and for certain coroner or medical examiner purposes.
Marketing. We will not use your PHI to market products or services without your authorization.
Sale of PHI. We will not sell your PHI.
Fundraising. We do not use your PHI for fundraising.

When we may share your information without your authorization

The law permits or requires us to share PHI in the situations below. We share only what is needed.

Required by law, including when a court orders us to, or a valid subpoena meets legal requirements. Therapist–client privilege may still protect your information, and we will assert it where we can.
Abuse or neglect. We must report suspected abuse or neglect of a child, an elder, or a dependent adult to the authorities.
Serious threats. We may disclose information to prevent or lessen a serious and imminent threat to you or to others, including warning an intended victim and notifying law enforcement or family when the law allows or requires it.
Public health and health oversight, such as reporting to public health authorities, or responding to a licensing board or other agency that oversees our work.
Law enforcement, as the law allows, for example to report certain injuries or respond to a lawful warrant.
Coroners, medical examiners, and funeral directors, in the event of a death.
Workers' compensation, if you file a claim that involves your mental health.
Armed forces and national security. If you are a member of the military, we may share information with command authorities when the law requires, and we may share information for authorized national security activities.
Family and friends involved in your care. We will share information with them only if you agree, or in an emergency when you cannot say so and we decide it is in your best interest.
Business associates. Companies that help us operate (for example billing, scheduling, telehealth, or secure email vendors) may handle your PHI under a written agreement to protect it.
Research, only as the law permits and with strong safeguards. We do not currently conduct research.
Government review. We must give the U.S. Department of Health and Human Services your information if it asks to check our compliance.

Your rights

To use any right below, contact our Privacy Officer using the information at the top of this notice. We may ask you to put your request in writing.

See and get a copy of your records. You may inspect and get a paper or electronic copy of your clinical and billing records, usually within 30 days of a written request. We may charge a reasonable, cost-based fee for copying. We may deny access to psychotherapy notes and in a few other limited cases; in many of those cases you may ask for a review of the denial.
Ask us to correct your records. If you believe something in your record is wrong or incomplete, you may ask us to amend it. We may deny the request in some cases, and if we do, you may file a statement of disagreement that we will attach to your record.
Get a list of disclosures. You may ask for an accounting of certain disclosures of your PHI we made in the six years before your request. It does not include disclosures for treatment, payment, health care operations, or those you authorized.
Ask us to limit how we use or share your information. We are not required to agree, except in one case: if you pay for a service in full, out of pocket, you may ask us not to tell your health plan about it, and we will agree unless the law requires otherwise.
Choose how we contact you. You may ask us to contact you only in a certain way or at a certain place (for example, by text rather than home phone, or at a different address). We will say yes to reasonable requests.
Get a paper copy of this notice, even if you agreed to receive it electronically.
Take back your authorization at any time, in writing, as described above.
Be told about a breach. We will notify you if your unsecured PHI is compromised.
File a complaint without fear of retaliation (see below).

Telehealth, electronic communication, and special protections

Telehealth sessions. We hold sessions through several platforms, including Headway, Tava, and Rula, which we use under a written agreement to protect your information. We do not record sessions unless you agree in writing. Please join from a private place, on a device and network you trust. We can provide care only when you are physically located in California, Florida, Michigan, or Texas during the session.

Email, text, and phone. Ordinary email and text messages are not fully secure and can be read by others. We use Proton Mail for anything about your care. If you ask us to use regular email or text, we will, after explaining the risks, but please keep those messages to scheduling and logistics. For emergencies, do not rely on email or text. Call 911 or 988.

Stronger state laws. California, Florida, Michigan, and Texas protect mental health records more strictly than federal law in some situations. When a state law gives you more privacy or more control than this notice, we follow the state law.

Substance use disorder (SUD) records. If you have received treatment from a program covered by federal rule 42 CFR Part 2 and that program shares your records with us, those records have extra protection. We may not use or disclose them in a civil, criminal, administrative, or legislative proceeding against you without your written consent or a court order issued after you have had notice and a chance to be heard. If you give a single written consent for all future treatment, payment, and health care operations, we may use and disclose those records for those purposes as HIPAA allows. We do not hold ourselves out as a substance use disorder treatment program.

Redisclosure. Information we disclose as this notice allows may be redisclosed by the person who receives it. If that person is not covered by federal privacy rules, the information may no longer be protected by them.

Changes to this notice

We may change this notice and our privacy practices at any time, and the new terms will apply to all PHI we hold. The current notice is posted on our website at counseling4change.org, shows its effective date at the top, and is available on request. We will give you a revised copy at your next session after a material change.

Questions and complaints

If you have questions about this notice, or believe we have violated your privacy rights, contact our Privacy Officer: Arthur H. Belmont, LMFT, +1 (888) 787-1767, Arthur.Belmont3@pm.me, 1317 Edgewater Drive, Suite #4546, Orlando, FL 32804-6350.

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, DC 20201, 1-877-696-6775, or through www.hhs.gov/ocr/privacy/hipaa/complaints/. Complaints generally must be filed within 180 days of when you knew of the problem.

We will not retaliate against you for filing a complaint.