WHO IS TREATING YOU

Therapist: Alexis Kattelman, CMHC

License type: Licensed Clinical Mental Health Counselor

License number: 13975213-6004

Contact: (801) 448-7620 

lexiekattelman@toolboxcounseling.org

Practicing under supervision?: No — Clinician is fully licensed.

You may verify any Utah professional license at secure.utah.gov/llv/search/index.html.

STANDARDS OF CARE AND ETHICAL BOUNDARIES

Your therapist is required to maintain professional boundaries with you, to exercise impartial professional judgment, and to practice consistent with the ethical code governing their license.

In a professional relationship with a mental health practitioner, a dual relationship between a client and a provider — or one that is romantic, financially motivated, sexual, or otherwise risks impacting the provider's judgment or the quality of the services provided — is never appropriate and should be reported to the Division of Professional Licensing.

     The statement above is required by Utah Code § 58-60-110(1)(e)(iii). If anything about your therapist's conduct toward you feels inappropriate, you are entitled to report it.

YOUR RIGHTS

You have the right to:

  • be treated with dignity and respect, and to receive services without discrimination;

  • know who is treating you, what license they hold, and whether they are supervised;

  • seek a second opinion at any time;

  • ask for additional information about your diagnosis, your treatment, your therapist's methods, and the alternatives, and to receive answers you can understand;

  • participate in setting and revising your treatment goals;

  • decline any particular intervention or technique;

  • give or withhold consent before any session is recorded or observed;

  • have your information kept confidential, subject to the exceptions the law requires;

  • access your own records;

  • be free from exploitation of any kind;

  • know what services cost before you receive them, including a Good Faith Estimate if you are uninsured or paying privately;

  • request an interpreter or other reasonable accommodation at no cost to you;

  • know why treatment might end, and to receive referrals if it does; and

  • terminate treatment at any time, unless you are in treatment under a court order that provides otherwise.

The Client Services Agreement explains each of these in detail.

TOOLBOX COUNSELING IS REQUIRED BY LAW TO:

  • maintain the privacy and security of your protected health information;

  • give you this Notice of our legal duties and privacy practices, and abide by the terms of the Notice currently in effect;

  • notify you if a breach occurs that compromises the privacy or security of your information; and

  • obtain your written acknowledgment that you received this Notice.

RAISING A CONCERN

With us. Tell your therapist, or contact Alexis Kattelman at lexiekattelman@toolboxcounseling.org or (801) 448-7620. We will acknowledge your concern within five business days and respond within fifteen business days. Raising a concern will not affect your care.

With the Division of Professional Licensing. You may contact DOPL at any time, whether or not you have raised the matter with us. Doing so will not affect your care at Toolbox Counseling.

Utah Division of Professional Licensing

160 East 300 South, Salt Lake City, UT 84111

Telephone: (801) 530-6628

Website: dopl.utah.gov

How to file a complaint: Complaint forms and instructions are available at dopl.utah.gov, or call the number above

About privacy specifically. You may also complain to the U.S. Department of Health and Human Services, Office for Civil Rights, at 1-877-696-6775 or www.hhs.gov/ocr/privacy/hipaa/complaints/. See the Notice of Privacy Practices.

We will not retaliate against you for raising a concern or filing a complaint anywhere.

IN AN EMERGENCY

Toolbox Counseling does not provide twenty-four-hour crisis coverage. If you are in immediate danger or experiencing a mental health emergency:

  • Call 911 or go to the nearest emergency room.

  • Call or text 988 — the Suicide and Crisis Lifeline, available twenty-four hours a day.

  • Utah Warm Line: 1-833-SPEAKUT (1-833-773-2588) — for support when you are not in crisis but need to talk.

  • Utah Domestic Violence Link Line: 1-800-897-LINK (5465)

Required Disclosures and Client Rights