{"id":14454,"date":"2025-05-09T13:25:29","date_gmt":"2025-05-09T20:25:29","guid":{"rendered":"https:\/\/siliconvalleymarriagecounseling.com\/?page_id=14454"},"modified":"2025-07-28T12:31:16","modified_gmt":"2025-07-28T19:31:16","slug":"notice-of-privacy-practices-portland","status":"publish","type":"page","link":"https:\/\/cms-staginglink3.com\/aziza-client-site\/portland\/notice-of-privacy-practices-portland\/","title":{"rendered":"Notice of Privacy Practices"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"14454\" class=\"elementor elementor-14454\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-f56fdf6 e-flex e-con-boxed e-con e-parent\" data-id=\"f56fdf6\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5ded433 elementor-widget elementor-widget-spacer\" data-id=\"5ded433\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-63a2f12 elementor-widget elementor-widget-spacer\" data-id=\"63a2f12\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-739edea e-flex e-con-boxed e-con e-parent\" data-id=\"739edea\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d092bcb elementor-widget elementor-widget-spacer\" data-id=\"d092bcb\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-0cfd37c e-con-full e-flex e-con e-child\" data-id=\"0cfd37c\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-25ff604 elementor-widget__width-initial elementor-widget elementor-widget-n-accordion\" data-id=\"25ff604\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;default_state&quot;:&quot;all_collapsed&quot;,&quot;max_items_expended&quot;:&quot;one&quot;,&quot;n_accordion_animation_duration&quot;:{&quot;unit&quot;:&quot;ms&quot;,&quot;size&quot;:400,&quot;sizes&quot;:[]}}\" data-widget_type=\"nested-accordion.default\">\n\t\t\t\t\t\t\t<div class=\"e-n-accordion\" aria-label=\"Accordion. Open links with Enter or Space, close with Escape, and navigate with Arrow Keys\">\n\t\t\t\t\t\t<details id=\"e-n-accordion-item-3980\" class=\"e-n-accordion-item\" >\n\t\t\t\t<summary class=\"e-n-accordion-item-title\" data-accordion-index=\"1\" tabindex=\"0\" aria-expanded=\"false\" aria-controls=\"e-n-accordion-item-3980\" >\n\t\t\t\t\t<span class='e-n-accordion-item-title-header'><div class=\"e-n-accordion-item-title-text\"> Please read the Notice of Privacy Practices. (Click here to expand.) <\/div><\/span>\n\t\t\t\t\t\t\t<span class='e-n-accordion-item-title-icon'>\n\t\t\t<span class='e-opened' ><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-minus\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M416 208H32c-17.67 0-32 14.33-32 32v32c0 17.67 14.33 32 32 32h384c17.67 0 32-14.33 32-32v-32c0-17.67-14.33-32-32-32z\"><\/path><\/svg><\/span>\n\t\t\t<span class='e-closed'><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-info-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119.043 8 8 119.083 8 256c0 136.997 111.043 248 248 248s248-111.003 248-248C504 119.083 392.957 8 256 8zm0 110c23.196 0 42 18.804 42 42s-18.804 42-42 42-42-18.804-42-42 18.804-42 42-42zm56 254c0 6.627-5.373 12-12 12h-88c-6.627 0-12-5.373-12-12v-24c0-6.627 5.373-12 12-12h12v-64h-12c-6.627 0-12-5.373-12-12v-24c0-6.627 5.373-12 12-12h64c6.627 0 12 5.373 12 12v100h12c6.627 0 12 5.373 12 12v24z\"><\/path><\/svg><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t<div role=\"region\" aria-labelledby=\"e-n-accordion-item-3980\" class=\"elementor-element elementor-element-86eafb1 e-con-full e-flex e-con e-child\" data-id=\"86eafb1\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-285983e elementor-widget elementor-widget-text-editor\" data-id=\"285983e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h3 class=\"\" data-start=\"272\" data-end=\"309\">Notice of Privacy Practices<\/h3><p class=\"\" data-start=\"310\" data-end=\"343\">Effective Date: April 22nd, 2025<\/p><p class=\"\" data-start=\"345\" data-end=\"474\">This notice explains how your health information may be used and disclosed and how you can access it. Please review it carefully.<\/p><hr class=\"\" data-start=\"476\" data-end=\"479\" \/><h3 class=\"\" data-start=\"481\" data-end=\"503\">1. Your Rights<\/h3><p class=\"\" data-start=\"505\" data-end=\"527\">You have the right to:<\/p><ul data-start=\"528\" data-end=\"825\"><li class=\"\" data-start=\"528\" data-end=\"558\"><p class=\"\" data-start=\"530\" data-end=\"558\">Get a copy of your records<\/p><\/li><li class=\"\" data-start=\"559\" data-end=\"598\"><p class=\"\" data-start=\"561\" data-end=\"598\">Request corrections to your records<\/p><\/li><li class=\"\" data-start=\"599\" data-end=\"670\"><p class=\"\" data-start=\"601\" data-end=\"670\">Request confidential communication (e.g., phone only, no voicemail)<\/p><\/li><li class=\"\" data-start=\"671\" data-end=\"704\"><p class=\"\" data-start=\"673\" data-end=\"704\">Ask us to limit what we share<\/p><\/li><li class=\"\" data-start=\"705\" data-end=\"757\"><p class=\"\" data-start=\"707\" data-end=\"757\">Get a list of people we&#8217;ve shared your info with<\/p><\/li><li class=\"\" data-start=\"758\" data-end=\"825\"><p class=\"\" data-start=\"760\" data-end=\"825\">File a complaint if you believe your privacy rights were violated<\/p><\/li><\/ul><hr class=\"\" data-start=\"827\" data-end=\"830\" \/><h3 class=\"\" data-start=\"832\" data-end=\"863\">2. Our Responsibilities<\/h3><p class=\"\" data-start=\"865\" data-end=\"884\">We are required to:<\/p><ul data-start=\"885\" data-end=\"1101\"><li class=\"\" data-start=\"885\" data-end=\"936\"><p class=\"\" data-start=\"887\" data-end=\"936\">Maintain the privacy of your health information<\/p><\/li><li class=\"\" data-start=\"937\" data-end=\"1011\"><p class=\"\" data-start=\"939\" data-end=\"1011\">Provide you with this notice of our legal duties and privacy practices<\/p><\/li><li class=\"\" data-start=\"1012\" data-end=\"1047\"><p class=\"\" data-start=\"1014\" data-end=\"1047\">Follow the terms of this notice<\/p><\/li><li class=\"\" data-start=\"1048\" data-end=\"1101\"><p class=\"\" data-start=\"1050\" data-end=\"1101\">Notify you if a breach compromises your information<\/p><\/li><\/ul><hr class=\"\" data-start=\"1103\" data-end=\"1106\" \/><h3 class=\"\" data-start=\"1108\" data-end=\"1156\">3. How We Use and Share Your Information<\/h3><p class=\"\" data-start=\"1158\" data-end=\"1202\">We may use or share your health information:<\/p><ul data-start=\"1203\" data-end=\"1545\"><li class=\"\" data-start=\"1203\" data-end=\"1270\"><p class=\"\" data-start=\"1205\" data-end=\"1270\">For treatment \u2013 to provide, coordinate, or manage your care<\/p><\/li><li class=\"\" data-start=\"1271\" data-end=\"1322\"><p class=\"\" data-start=\"1273\" data-end=\"1322\">For payment \u2013 to bill for services provided<\/p><\/li><li class=\"\" data-start=\"1323\" data-end=\"1407\"><p class=\"\" data-start=\"1325\" data-end=\"1407\">For health care operations \u2013 for practice management and quality improvement<\/p><\/li><li class=\"\" data-start=\"1408\" data-end=\"1478\"><p class=\"\" data-start=\"1410\" data-end=\"1478\">With your written authorization \u2013 for any use not listed above<\/p><\/li><li class=\"\" data-start=\"1479\" data-end=\"1545\"><p class=\"\" data-start=\"1481\" data-end=\"1545\">As required by law \u2013 such as reporting abuse or court orders<\/p><\/li><\/ul><hr class=\"\" data-start=\"1547\" data-end=\"1550\" \/><h3 class=\"\" data-start=\"1552\" data-end=\"1587\">4. Electronic Communication<\/h3><p class=\"\" data-start=\"1589\" data-end=\"1794\">If you authorize us, we may use email or text messaging to confirm appointments or send brief messages. These methods are not fully secure. We will ask for your consent separately before using these tools.<\/p><hr class=\"\" data-start=\"1796\" data-end=\"1799\" \/><h3 class=\"\" data-start=\"1801\" data-end=\"1838\">5. State-Specific Protections<\/h3><p class=\"\" data-start=\"1840\" data-end=\"2046\"><strong>California:<\/strong><br data-start=\"1855\" data-end=\"1858\" \/>Under the California Confidentiality of Medical Information Act (CMIA), your mental health records may be more strictly protected than under HIPAA. We will comply with both HIPAA and CMIA.<\/p><p class=\"\" data-start=\"2048\" data-end=\"2221\"><strong>Oregon:<\/strong><br data-start=\"2059\" data-end=\"2062\" \/>Oregon law may require your specific authorization before disclosing mental health or psychotherapy notes. We follow the more protective rule where applicable.<\/p><hr class=\"\" data-start=\"2223\" data-end=\"2226\" \/><h3 class=\"\" data-start=\"2228\" data-end=\"2261\">6. Changes to This Notice<\/h3><p class=\"\" data-start=\"2263\" data-end=\"2431\">We may update this notice at any time. The revised notice will be available in our office and on our website. Changes apply to all health information we have about you.<\/p><hr class=\"\" data-start=\"2433\" data-end=\"2436\" \/><h3 class=\"\" data-start=\"2438\" data-end=\"2472\">7. Questions or Complaints<\/h3><p class=\"\" data-start=\"2474\" data-end=\"2586\">If you have questions or concerns about this notice, or believe your rights have been violated, you may contact:<\/p><p class=\"\" data-start=\"2588\" data-end=\"2670\"><strong>Privacy Officer<\/strong><br data-start=\"2607\" data-end=\"2610\" \/>Azizeh Rezayian<br \/>Azizeh@https:\/\/cms-staginglink3.com\/aziza-client-site\/<\/p><p class=\"\" data-start=\"2672\" data-end=\"2800\">You can also file a complaint with the U.S. Department of Health and Human Services at <a target=\"_new\" rel=\"noopener\" data-start=\"2759\" data-end=\"2799\">www.hhs.gov\/ocr\/privacy\/hipaa\/complaints<\/a>.<\/p><p class=\"\" data-start=\"2802\" data-end=\"2859\">We will not retaliate against you for filing a complaint.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d38728f elementor-widget elementor-widget-button\" data-id=\"d38728f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"#\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Download  this document<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f6477de elementor-widget elementor-widget-button\" data-id=\"f6477de\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"#\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Download  this document<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f2d25ac elementor-widget elementor-widget-text-editor\" data-id=\"f2d25ac\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h2>Please Read and Complete the Following<\/h2>\n<p>Before your first session, please read the Notice of Privacy Practices above. This explains how your health information may be used and protected.<\/p>\n<p>Then, fill out the form below to:<\/p>\n<ul>\n<li>Confirm you\u2019ve received the notice<\/li>\n<li>Indicate how you prefer to communicate<\/li>\n<li>Provide your signature and consent<\/li>\n<\/ul>\n<p>If you have any questions, feel free to contact us before signing.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-af70b9f elementor-widget elementor-widget-spacer\" data-id=\"af70b9f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2a63f33 fluent-form-widget-step-header-yes fluent-form-widget-step-progressbar-yes fluentform-widget-submit-button-custom elementor-widget elementor-widget-fluent-form-widget\" data-id=\"2a63f33\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"fluent-form-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\n            <div class=\"fluentform-widget-wrapper fluentform-widget-custom-radio-checkbox fluentform-widget-align-default\">\n\n            \n            <div class='fluentform ff-default fluentform_wrapper_12 ffs_default_wrap'><form data-form_id=\"12\" id=\"fluentform_12\" class=\"frm-fluent-form fluent_form_12 ff-el-form-top ff_form_instance_12_1 ff-form-loading ffs_default\" data-form_instance=\"ff_form_instance_12_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">HIPAA Acknowledgment and Communication Consent Form (Portland)<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='14454' \/><input type=\"hidden\" id=\"_fluentform_12_fluentformnonce\" name=\"_fluentform_12_fluentformnonce\" value=\"44b1a81301\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/aziza-client-site\/wp-json\/wp\/v2\/pages\/14454\" \/><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-12_1\" ><h3 class='ff-el-section-title'>HIPAA Acknowledgment and Communication Consent Form<\/h3><div class='ff-section_break_desk'><p>Including for use in California and Oregon<\/p><\/div><hr \/><\/div><div data-type=\"name-element\" data-name=\"names\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_12_names_first_name_' id='label_ff_12_names_first_name_' >First Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[first_name]\" id=\"ff_12_names_first_name_\" class=\"ff-el-form-control\" placeholder=\"Enter Your First Name\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_12_names_last_name_' id='label_ff_12_names_last_name_' >Last Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[last_name]\" id=\"ff_12_names_last_name_\" class=\"ff-el-form-control\" placeholder=\"Enter Your Last Name\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_12_input_text_1' id='label_ff_12_input_text_1' aria-label=\"Date of birth.\">Date of birth.<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_1\" class=\"ff-el-form-control\" placeholder=\"MM\/DD\/YYYY\" data-name=\"input_text_1\" id=\"ff_12_input_text_1\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-12_2\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><h3 data-start=\"454\" data-end=\"524\">1. Acknowledgment of Receipt of HIPAA Notice of Privacy Practices<\/h3>\n<p data-start=\"454\" data-end=\"524\">I acknowledge that I have received a copy of the therapist\u2019s <strong data-start=\"587\" data-end=\"618\">Notice of Privacy Practices<\/strong>. This notice describes how my health information may be used and disclosed, and how I can access this information under the <strong data-start=\"743\" data-end=\"806\">Health Insurance Portability and Accountability Act (HIPAA)<\/strong>.<\/p>\n<p class=\"\" data-start=\"809\" data-end=\"870\">\u00a0<\/p><\/div><hr \/><\/div><div class='ff-el-group'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_7597bfcf26f0d4f91e3f11d7ef1d512e'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"I have read and understood the Notice of Privacy Practices.\"  id='input_radio_7597bfcf26f0d4f91e3f11d7ef1d512e' aria-label='I have read and understood the Notice of Privacy Practices.' aria-invalid='false' aria-required=true> <span>I have read and understood the Notice of Privacy Practices.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_f3d58e6096f8cb22f91de946fe9aa70a'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"I was offered a copy but declined.\"  id='input_radio_f3d58e6096f8cb22f91de946fe9aa70a' aria-label='I was offered a copy but declined.' aria-invalid='false' aria-required=true> <span>I was offered a copy but declined.<\/span><\/label><\/div><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-12_3\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><h3>2. State-Specific Privacy Disclosures<\/h3>\n<h4>California Clients:<\/h4>\n<p>I understand that my therapist also complies with the <strong>California Confidentiality of Medical Information Act (CMIA)<\/strong>, which offers additional protections for my personal health information, including mental health information.<\/p>\n<h4>Oregon Clients:<\/h4>\n<p>I understand that Oregon law may provide additional privacy protections for mental health records, and that disclosures are limited to those permitted by state and federal law.<\/p>\n<h3>3. Electronic Communication Consent<\/h3>\n<p>I understand that my therapist may use <strong>email, text messaging, or other electronic methods<\/strong> to communicate with me for scheduling or administrative purposes.<\/p>\n<p>I acknowledge the following:<\/p>\n<ul>\n<li>These methods <strong data-start=\"1677\" data-end=\"1723\">may not be fully secure or HIPAA-compliant<\/strong>.<\/li>\n<li>There is a <strong data-start=\"1740\" data-end=\"1773\">risk of unintended disclosure<\/strong> if messages are intercepted or accessed by unauthorized parties.<\/li>\n<li>I may revoke my consent in writing at any time.<\/li>\n<\/ul>\n<p><span style=\"color: #ffffff\">white<\/span><\/p><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Decline\">Decline<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_651d1c14f9f8ba40dcfeeec21884c723'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"I do not wish to be contacted via email or text.\"  id='checkbox_2_651d1c14f9f8ba40dcfeeec21884c723' aria-label='I do not wish to be contacted via email or text.' aria-invalid='false' aria-required=false> <span>I do not wish to be contacted via email or text.<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Email communications\">Email communications<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_c3593ad2ef584f4e03ee18b0a7cf89d5'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"I consent to communication via email at:\"  id='checkbox_c3593ad2ef584f4e03ee18b0a7cf89d5' aria-label='I consent to communication via email at:' aria-invalid='false' aria-required=true> <span>I consent to communication via email at:<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_07ccc5c552b89bd7528b5e2eeab4787a'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"&lt;b&gt;I DO NOT consent&lt;\/b&gt; to communication via email at:\"  id='checkbox_07ccc5c552b89bd7528b5e2eeab4787a' aria-label='&lt;b&gt;I DO NOT consent&lt;\/b&gt; to communication via email at:' aria-invalid='false' aria-required=true> <span><b>I DO NOT consent<\/b> to communication via email at:<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_12_email' id='label_ff_12_email' aria-label=\"Email\">Email<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" id=\"ff_12_email\" class=\"ff-el-form-control\" placeholder=\"Email Address\" data-name=\"email\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Text message communication.\">Text message communication.<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_d0a07dc14204e8dc9698b8536cbeacfa'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"I consent to communication via text message at:\"  id='checkbox_1_d0a07dc14204e8dc9698b8536cbeacfa' aria-label='I consent to communication via text message at:' aria-invalid='false' aria-required=false> <span>I consent to communication via text message at:<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_30088d11ee1c0ae4cfa30718e7d78632'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"&lt;b&gt;I DO NOT consent&lt;\/b&gt; to communication via text message at:\"  id='checkbox_1_30088d11ee1c0ae4cfa30718e7d78632' aria-label='&lt;b&gt;I DO NOT consent&lt;\/b&gt; to communication via text message at:' aria-invalid='false' aria-required=false> <span><b>I DO NOT consent<\/b> to communication via text message at:<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_12_phone' id='label_ff_12_phone' aria-label=\"Phone\/Mobile\">Phone\/Mobile<\/label><\/div><div class='ff-el-input--content'><input name=\"phone\" class=\"ff-el-form-control ff-el-phone\" type=\"tel\" placeholder=\"Mobile Number\" data-name=\"phone\" id=\"ff_12_phone\" inputmode=\"tel\"  aria-invalid='false' aria-required=false><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-12_4\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><h3 data-start=\"2099\" data-end=\"2116\">4. Signature<\/h3>\n<p class=\"\" data-start=\"2118\" data-end=\"2171\">By writing my name as a signature below, I acknowledge and accept the above:<\/p>\n<p data-start=\"2118\" data-end=\"2171\"><span style=\"color: #ffffff\">white<\/span><\/p><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_12_input_text' id='label_ff_12_input_text' aria-label=\"Client signature\">Client signature<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" data-name=\"input_text\" id=\"ff_12_input_text\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_12_datetime_1' id='label_ff_12_datetime_1' aria-label=\"Date\">Date<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Date Use arrow keys to navigate dates. 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<\/div>\n\n            \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-40e4c41 elementor-widget elementor-widget-spacer\" data-id=\"40e4c41\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Please read the Notice of Privacy Practices. (Click here to expand.) Notice of Privacy Practices Effective Date: April 22nd, 2025 This notice explains how your health information may be used and disclosed and how you can access it. Please review it carefully. 1. Your Rights You have the right to: Get a copy of your [&hellip;]<\/p>\n","protected":false},"author":34,"featured_media":0,"parent":14273,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-14454","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Notice of Privacy Practices | Portland Couples Therapy<\/title>\n<meta name=\"description\" content=\"Learn how Azizeh Rezaiyan Couples Therapy in Portland, Oregon protects your privacy and confidentiality in counseling services.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/cms-staginglink3.com\/aziza-client-site\/portland\/notice-of-privacy-practices-portland\/\" \/>\n<meta property=\"og:locale\" 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