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Privacy & practice policies

Notice of Privacy Practices

Your information. Your rights. Our responsibilities. Effective September 23, 2026. Our Consent for Treatment and Practice Policies and Website Privacy and Cookies follow below.

Effective Date: September 23, 2026

This notice describes:

  • HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
  • YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
  • HOW TO FILE A COMPLAINT ABOUT A VIOLATION OF THE PRIVACY OR SECURITY OF YOUR INFORMATION OR OF YOUR RIGHTS

YOU HAVE A RIGHT TO A COPY OF THIS NOTICE IN PAPER OR ELECTRONIC FORM AND TO DISCUSS IT WITH ZALFI'S PRIVACY OFFICER AT 317-296-7707 OR CONTACT@ZALFI.ORG.

This notice also explains how you can obtain access to your records. Please review it carefully.

Zalfi LLC (“Zalfi” or “we”) protects the privacy of the health information it creates and maintains. This notice applies to Zalfi's psychiatric and therapy services. Some records relating to substance use disorder (SUD) services have additional protections under 42 CFR Part 2, as explained below. A diagnosis of SUD alone does not necessarily make every record a Part 2 record.

Zalfi does not provide emergency or inpatient services. For an emergency, call 911 or go to the nearest emergency department.

Your rights

To exercise these rights, contact our Privacy Officer using the information at the end of this notice.

  • Access your records. You may request to see or receive an electronic or paper copy of your medical record and other health information we maintain about you. We generally provide a copy or summary within 30 days and may charge a reasonable, cost-based fee as allowed by law. Access through our secure patient portal may also be available.
  • Request a correction. You may ask us to correct information you believe is inaccurate or incomplete. We may deny a request, but will explain why in writing, generally within 60 days. You may submit a statement of disagreement.
  • Request confidential contact. You may ask us to contact you in a particular way or at a different address. We will accommodate reasonable requests.
  • Request restrictions. You may ask us to limit certain uses or disclosures for treatment, payment, or health care operations, or to limit sharing with people involved in your care. We are generally not required to agree. If we agree, disclosures for emergency treatment or as required by law may still be allowed. If you pay out of pocket in full for a service, you may request that we not share information about that service with your health plan for payment or health care operations; we will honor that request unless disclosure is required by law. If your records are subject to Part 2 and you have signed a consent for treatment, payment, and health care operations disclosures, you may also ask us to restrict disclosures under that consent.
  • Request an accounting of disclosures. You may request a list of certain disclosures we have made during the previous six years. HIPAA excludes some disclosures from this accounting, including many disclosures for treatment, payment, and health care operations. We provide one accounting in a 12-month period without charge; additional requests may incur a reasonable fee. Part 2 provides additional accounting rights for covered SUD records; the federal compliance date for those new accounting requirements will be established by a future HIPAA rule.
  • Receive this notice. You may request a paper copy at any time, even if you receive it electronically. If your records are subject to Part 2, you may discuss this notice with us.
  • Choose a personal representative. A person with legal authority to act for you may exercise your privacy rights. We will verify that authority before acting.
  • Complain without retaliation. You may complain to us or to the U.S. Department of Health and Human Services Office for Civil Rights (OCR). We will not retaliate against you. Contact details appear below.

Your choices

For information shared with family, friends, or others involved in your care or payment for your care, tell us your preferences. You may also tell us your preferences for disaster relief. If you cannot tell us, we may act in your best interest or as needed to reduce a serious and imminent threat, subject to any additional limits that apply to the records.

We generally need your written authorization for marketing, sale of your information, and most uses or disclosures of separately maintained psychotherapy notes. Separately maintained SUD counseling notes, if any, require a separate consent when required by Part 2. Zalfi does not use patient information for fundraising. If we propose fundraising that uses your Part 2 information in the future, you have the right to advance notice and to choose not to receive those communications.

How we use and disclose health information

HIPAA generally permits us to use and disclose health information for treatment, payment, and health care operations without a separate HIPAA authorization, subject to applicable Indiana law and the additional Part 2 rules described below. For example, we may share information with a clinician treating you, submit a claim to your insurer, or use information to manage and improve our services.

Federal and state law also permit or require some other uses or disclosures, subject to their conditions. These may include public health reporting; reporting abuse or neglect; responding to a serious threat; research with required safeguards; health oversight; organ and tissue donation; communications with a coroner or medical examiner; workers' compensation; lawful government requests; and responding to legal proceedings. We review requests under the law applicable to the particular record before releasing information. The Part 2 section below limits these examples when a record is protected by Part 2.

Additional protections for SUD records under 42 CFR Part 2

Part 2 protects certain records held by a federally assisted SUD diagnosis, treatment, or referral program, and can also restrict certain recipients of those records. When Part 2 applies to records held by Zalfi, we follow its additional confidentiality requirements along with HIPAA and Indiana law.

Consent for sharing. Part 2 generally requires a patient's written consent before a use or disclosure that would identify the patient as receiving SUD services, unless Part 2 specifically permits the use or disclosure without consent. For example, sharing a Part 2 record with an outside treating provider or health plan for routine treatment or billing generally requires a valid Part 2 consent. You may give one separate written or electronic consent for future treatment, payment, and health care operations uses and disclosures. Zalfi's general Consent for Treatment and general insurance billing language do not serve as that separate Part 2 disclosure consent. We ask you to sign a separate Part 2 form when needed. You may revoke that consent in writing through the Privacy Officer, except to the extent a lawful holder has already acted in reliance on it. Other uses or disclosures that require consent will require an appropriate separate consent.

Sharing without consent where permitted. Part 2 permits specific uses or disclosures without patient consent when its conditions are met. Examples include communications within a Part 2 program and with qualified service organizations performing services for it; bona fide medical emergencies; certain research; authorized audits or evaluations; required reports of suspected child abuse or neglect; limited reports of crimes or threats on program premises or against personnel; and certain cause-of-death inquiries. A Part 2 court order may permit disclosure in limited circumstances, but an order alone does not necessarily compel release. These are limited exceptions; general HIPAA permission by itself does not override Part 2 restrictions.

Redisclosure. When Zalfi discloses a Part 2 record with your consent, the disclosure will include the notice required by 42 CFR 2.32 and a copy of your consent or a clear description of its scope. A HIPAA-covered provider, health plan, or business associate that receives a Part 2 record under your consent for treatment, payment, or health care operations may further use or disclose the information as HIPAA permits. Such information may no longer be protected by Part 2 after a permitted redisclosure. Restrictions on use of Part 2 records in proceedings against you continue to apply.

Investigations and legal proceedings against you. Part 2 records, and testimony describing them, will not be used or disclosed in a civil, criminal, administrative, or legislative investigation or proceeding against you without your specific written consent or a Part 2 compliant court order. Where required by law, the court process includes notice and an opportunity for you or the holder of the records to be heard. An order authorizing disclosure must also be accompanied by a subpoena or similar legal mandate compelling disclosure. We review each request before releasing records.

Additional Part 2 rights. You may ask us to restrict disclosures under a prior Part 2 consent for treatment, payment, or health care operations. You may request the applicable accounting of disclosures, including the additional three-year accounting for electronic records when that requirement takes effect; its federal compliance date has not yet been set by HHS. If a Part 2 intermediary has received your records, you may request the applicable list of its disclosures for the past three years. You may obtain a paper or electronic copy of this notice and discuss it with our Privacy Officer.

Our responsibilities and Indiana law

We must protect the privacy and security of your health information, follow the terms of this notice currently in effect, and provide a copy of the notice as required. We use safeguards and limit access to authorized personnel. We will notify affected people when a breach of unsecured information requires notice. We make reasonable efforts to limit information to the minimum necessary when that standard applies.

Indiana law also protects mental health records. We release those records with patient consent or under an applicable legal exception, and apply Indiana's requirements whenever they provide greater protection. We will not use or disclose information for a purpose outside this notice unless you authorize it in writing or applicable law permits or requires it. For Part 2 records, uses or disclosures for purposes not described in this notice require your written consent unless applicable law specifically permits or requires them. You may revoke a written HIPAA authorization in writing, subject to uses or disclosures already made in reliance on it.

Some services are provided by telehealth. We take reasonable steps to protect those communications. Ordinary email and text messaging may not be secure; you may request another way to communicate with us.

Changes to this notice

We may change this notice and apply the revised terms to information we already maintain. When a change takes effect, the updated notice will be available on our website and upon request. We will provide or distribute an updated notice when required by law.

Privacy contact and complaints

Privacy Officer: Chyane H.

Zalfi LLC, 821 N State Rd 135, Greenwood, IN 46142

Phone: 317-296-7707

Email: contact@zalfi.org

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights at 200 Independence Avenue SW, Washington, DC 20201; 1-877-696-6775; or https://www.hhs.gov/hipaa/filing-a-complaint/. Zalfi will not retaliate against you for filing a complaint.

Effective Date: September 23, 2026

This form is called a Consent for Treatment and Practice Policies (the “Consent”). Your therapist, counselor, psychologist, physician, nurse practitioner, or other health professional (“Provider”) at Zalfi LLC (“Zalfi” or the “Practice”) has asked you to read and sign this Consent before beginning services. Please review it carefully and ask your Provider any questions you may have.

Consent to Treatment

Treatment is a collaborative process in which you and your Provider work toward goals identified through assessment and treatment planning.

Depending on your needs and the services available, treatment may include psychiatric evaluation, medication management, individual therapy, addiction treatment, laboratory or diagnostic testing, education, care coordination, referrals, or other clinically appropriate services.

When operational and clinically appropriate, Zalfi may also provide standard outpatient addiction treatment, mental health intensive outpatient treatment, addiction intensive outpatient treatment, individual counseling, group counseling, or an appropriate combination of services. Enrollment in an intensive outpatient program or other specialized service may require a separate program agreement.

Your Provider will recommend services based on your symptoms, diagnosis, functioning, safety, treatment goals, available supports, and appropriate level of care. You may require an in-person examination, laboratory testing, drug screening, emergency evaluation, or services from another provider or facility.

You may accept or decline a recommended service. Your Provider will explain the expected benefits, material risks, reasonable alternatives, and likely consequences of declining treatment when clinically appropriate.

Independent Choice and Provider Selection

You understand that you may locate and select healthcare providers through public sources such as online directories, professional listings, or Zalfi’s website.

You acknowledge that your decision to begin care with your Provider or Zalfi is voluntary. To the best of your knowledge, the Provider or Zalfi staff have not personally solicited you to transfer your care from another organization or platform.

Provider Assignment and Coverage

Zalfi may assign or delegate aspects of your care to qualified professionals, including associate clinicians, covering clinicians, consultants, students or trainees under appropriate supervision, or other members of the treatment team.

You will be informed of a material change in your assigned Provider whenever reasonably feasible. If you object to a proposed substitution, you may discuss available alternatives or request transfer to another clinician. Zalfi cannot guarantee the continued availability of a particular Provider.

Some Providers at Zalfi are independent contractors rather than employees of the Practice. All Providers are expected to practice within their qualifications, licensure, supervision, and professional scope.

Treatment Benefits, Risks, and Outcomes

Potential benefits of treatment may include improved understanding, functioning, coping, relationships, recovery, symptom management, and quality of life.

Treatment may also involve risks, including uncomfortable emotions, discussion of difficult experiences, changes in relationships or routines, medication side effects, or a temporary increase in distress.

No guarantee has been made regarding the outcome of any evaluation, therapy, medication, treatment, test, procedure, referral, or other service. Your Provider will use professional judgment when recommending and providing services.

Telehealth Services

Telehealth uses electronic audio and video technology to provide services when you and your Provider are in different locations.

To participate in telehealth, you ordinarily need an internet connection and a device with a camera and microphone. Your Provider will explain how to access the telehealth platform and any available features.

At the beginning of a telehealth appointment, you may be asked to confirm your identity, current physical location, telephone number, emergency contact information, and the identity of anyone else present.

You may withdraw your consent to telehealth by notifying Zalfi. Withdrawal will not affect services already provided. If telehealth is no longer safe or clinically appropriate, your Provider may recommend an in-person evaluation, a different treatment method, a higher level of care, or transfer to another provider.

Federal or state law, professional standards, payer requirements, or clinical circumstances may require an in-person examination for certain services or medications.

Telehealth is not an emergency service. If you are experiencing an emergency, call 911 or go to the nearest emergency department. You may also call or text 988 for crisis support.

Risks of Telehealth

  • Another person may overhear or view a session if you participate from a location that is not private.
  • Internet, audio, video, equipment, or platform problems may interrupt the appointment.
  • Your Provider may be unable to perform certain physical examinations, testing, monitoring, or interventions remotely.
  • Responding to an emergency may be more difficult because your Provider is not physically present with you.
  • Electronic communication systems have security safeguards, but no system can be guaranteed to be completely secure.

Potential Benefits of Telehealth

  • Improved access to care
  • Reduced travel time
  • Greater scheduling flexibility
  • Improved continuity of treatment when telehealth is clinically appropriate

Telehealth Expectations

  • Participate from a private and reasonably quiet location whenever possible.
  • Take reasonable steps to prevent others from hearing the session or seeing your screen.
  • Do not participate while driving or operating equipment.
  • Do not record a session without your Provider’s prior written permission.
  • Tell your Provider if another person is present.
  • Tell your Provider your current physical location at the beginning of the session or whenever your location changes.
  • Follow the agreed-upon backup communication plan if the connection fails.
  • Seek emergency assistance when instructed or when immediate help is needed.

Support staff may assist with technology or equipment when necessary. You will be informed if another person needs to participate in the visit, and unnecessary participants will be asked to leave.

Limitations of Zalfi’s Services

You understand and acknowledge the following:

  • Zalfi does not provide emergency, inpatient, residential, or withdrawal-management services.
  • Some mental health, substance use, or medical conditions require emergency intervention, hospitalization, withdrawal management, residential treatment, partial hospitalization, in-person evaluation, or another service beyond Zalfi’s scope.
  • Telehealth may not be clinically appropriate for every patient or condition.
  • Services may be restricted or unavailable because of clinical circumstances, staffing, capacity, licensure requirements, payer requirements, or applicable law.
  • If Zalfi cannot safely provide or continue a needed service, staff will explain the concern and provide appropriate referral or transition information when reasonably possible.
  • Treatment outcomes cannot be guaranteed.

Confidentiality

Zalfi uses and discloses health information as described in its HIPAA and 42 CFR Part 2 Notice of Privacy Practices and as permitted or required by applicable law.

Some uses and disclosures may occur without a separate authorization, while others require written authorization or consent. Examples of permitted or required uses and disclosures may include:

  • Treatment, payment, and healthcare operations when permitted by applicable law
  • Communication with healthcare professionals involved in your care
  • Medical emergencies
  • Reporting abuse, neglect, or exploitation
  • Preventing or reducing a serious and imminent threat to health or safety
  • Legally valid court orders or other lawful process
  • Approved audits, evaluations, oversight, and regulatory activities

This list is not exhaustive. Additional information about Zalfi’s privacy practices and your rights is provided in Zalfi’s HIPAA and 42 CFR Part 2 Notice of Privacy Practices.

Substance Use Disorder Records

Some records concerning substance use disorder diagnosis, treatment, or referral are protected by additional federal confidentiality requirements under 42 CFR Part 2.

When Part 2 applies and a proposed use or disclosure requires your written consent, Zalfi will provide a separate Part 2 Consent for Use or Disclosure for you to review and sign electronically or on paper.

Signing this general Consent for Treatment does not authorize a use or disclosure of Part 2 records that requires separate consent. Zalfi may use or disclose Part 2 records without patient consent only when applicable law permits.

If you revoke a separate Part 2 consent, the revocation will apply to future uses and disclosures under that consent, except to the extent that Zalfi or another lawful holder has already acted in reliance on it.

Records and Patient Access

Your Provider is required to maintain records concerning your assessment, diagnosis, treatment, medications, services, treatment plan, progress, communications, and other clinically or administratively relevant information.

Records are maintained in TherapyNotes or another approved record system using appropriate administrative, technical, and physical safeguards.

You may request access to, inspect, or obtain copies of your records as described in Zalfi’s Notice of Privacy Practices and applicable law. You do not need to sign a Part 2 disclosure consent to access your own Part 2 records.

Record-Copy Fees

Zalfi may charge applicable fees for producing paper copies of records in accordance with current federal and Indiana law.

For a patient-access request governed by HIPAA, any fee will be reasonable and cost-based and limited to the expenses permitted by federal law. When the patient requests that paper records be mailed, the fee may include the actual cost of postage.

For other properly authorized paper-record requests, Zalfi may charge copying, labor, mailing, expedited-processing, or certification fees up to the limits permitted by current Indiana law.

Zalfi will provide a digital copy of or digital access to an electronic health record without charge when required by Indiana law.

Payment of a record-production fee does not authorize Zalfi to disclose records. Every disclosure must have a valid authorization, Part 2 consent, court order, or other legal basis.

Communications

Communications outside scheduled appointments may not be reviewed immediately and must not be used for emergencies.

Text Messages and Email

Text messages and ordinary email may not be secure and should not be used to communicate highly sensitive or urgent information.

By providing a telephone number, you consent to receive appointment reminders and appropriate practice communications by telephone or SMS text message. Message and data rates may apply. You may reply STOP to opt out of nonessential text messages.

You are responsible for considering who may have access to your telephone, email account, voicemail, text messages, or other communication devices.

Secure Communication

The patient portal or another Zalfi-approved secure method is the preferred way to communicate sensitive information electronically. Portal messages and other clinically relevant communications may become part of your medical record.

Social Media and Review Websites

Zalfi Providers generally will not respond to friend requests, direct messages, mentions, posts, or other patient communications through social media. This protects confidentiality and maintains professional boundaries.

You are not required or expected to follow Zalfi or your Provider on social media or leave an online review.

If you voluntarily post an online review, the information may become public, may be copied to other websites, and may be difficult to remove. Zalfi may be unable to respond because doing so could affect your confidentiality.

Fees and Financial Responsibility

You are responsible for applicable fees, copayments, coinsurance, deductibles, noncovered services, and other patient-responsibility amounts, except where prohibited by law or by Zalfi’s agreement with your health plan.

Charges vary based on the service, Provider, appointment duration, insurance coverage, network status, authorization requirements, and other applicable factors. Zalfi is not required to list the price of every available service in this Consent.

Applicable financial information may be provided through Zalfi’s current fee schedule, insurance-benefit information, a Good Faith Estimate, or a separate service or program agreement.

If you do not have insurance or do not plan to use insurance to pay for services, Zalfi will provide a Good Faith Estimate when required by federal law. You may also request a Good Faith Estimate before scheduling a service.

Signing this Consent does not enroll you in an intensive outpatient program or obligate you to pay for a service you have not agreed to receive. If you later enroll in an IOP or another service with a materially different schedule or billing structure, applicable financial information will be provided before services begin.

Cancellation and No-Show Policy

Contact Zalfi at least 24 hours before an appointment if you need to cancel or reschedule.

Unless prohibited by law or Zalfi’s agreement with your insurance plan, Zalfi may charge an $80 fee for a late cancellation, missed appointment, or failure to attend without notice. Insurance ordinarily does not pay late-cancellation or no-show fees.

Three missed appointments within a 12-month period may result in review for discharge from the Practice. Zalfi will consider clinical circumstances, safety, continuity needs, payer requirements, and reasonable accommodations before making a discharge decision.

Insurance Benefits and Billing Authorization

You authorize Zalfi to submit claims to your primary and secondary insurers or other third-party payers for services provided to you. You authorize applicable benefits to be paid directly to Zalfi when permitted by your health plan.

This general billing authorization does not replace a separate Part 2 consent when Part 2 requires patient consent for disclosure of records to an insurer, health plan, third-party payer, billing service, or other recipient.

You are responsible for confirming with your insurance plan:

  • Whether your benefits cover the services you will receive
  • Whether telehealth or in-person services are covered
  • Whether prior authorization or a referral is required
  • Whether your Provider is in-network or out-of-network
  • Your deductible, copayment, coinsurance, or other financial responsibility
  • Whether the plan covers individual treatment, group treatment, addiction treatment, or IOP services

When you use insurance benefits, Zalfi may need to disclose information required for eligibility verification, authorization, utilization review, claims submission, payment, or coordination of benefits. HIPAA and 42 CFR Part 2 apply as described in Zalfi’s Notice of Privacy Practices.

A health plan’s refusal to pay for a service does not automatically eliminate your financial responsibility unless applicable law or a payer agreement provides otherwise.

Payment Methods and Outstanding Balances

Zalfi may require a valid credit or debit card to be maintained securely on file when permitted by law and the applicable payer agreement.

The card may be charged for disclosed patient-responsibility amounts and applicable fees unless other arrangements have been approved in advance. You are responsible for keeping your payment information current.

Payment is generally due at the time of service. If you cannot pay an amount when due, contact Zalfi to discuss available arrangements.

Outstanding balances remain due until paid or otherwise resolved. When permitted by applicable law and confidentiality requirements, an unpaid balance may be referred to a collection service.

Part 2 records will not be disclosed for collection unless the disclosure is authorized or otherwise permitted by Part 2.

Drug and Alcohol Screening

Zalfi may require drug or alcohol screening when clinically appropriate, required by a treatment program, related to medication safety, or required under an applicable controlled-medication policy.

Testing may include urine, blood, breath, oral-fluid, or another clinically appropriate test and may be completed by Zalfi or an outside laboratory.

When screening is required:

  • You may be asked to complete testing within a stated period, which may be within 24 hours.
  • You must inform your Provider of prescribed medications, nonprescription medications, supplements, alcohol, cannabis, or other substances that could affect the result.
  • An unexpected or abnormal result may require discussion, confirmation testing, changes in monitoring, medication changes, referral, or a different level of care.
  • Refusal or failure to complete clinically required testing may affect the Provider’s ability to prescribe certain medications or continue a particular treatment safely.

Results are handled according to applicable privacy and confidentiality requirements, including Part 2 when applicable.

Destruction of Property

The client is responsible for any and all destruction to Facility property or other property belonging to others that may be in the Facility. By signing this form, the client agrees to these terms of liability and agrees to reimburse the Facility or other individuals for any property destruction and/or damage.

Ending or Transferring Treatment

The length of treatment varies according to clinical need, progress, patient preferences, attendance, available services, and other circumstances.

Treatment may end because:

  • You complete treatment or no longer request services.
  • You request transfer or discharge.
  • You require a service or level of care Zalfi does not provide.
  • Telehealth is no longer safe or clinically appropriate.
  • A Provider leaves Zalfi or becomes unavailable.
  • Repeated missed appointments prevent effective treatment.
  • Payment or insurance issues prevent continuation, subject to applicable requirements.
  • You materially violate program rules or engage in threatening, abusive, fraudulent, or unsafe conduct.
  • Zalfi is otherwise unable to continue services safely or lawfully.

When treatment ends, Zalfi will make reasonable efforts to provide notice, address immediate safety concerns, complete appropriate discharge planning, and provide referral or follow-up information when clinically indicated.

Ending services does not eliminate your responsibility for amounts already owed.

Consumer Rights

You have rights concerning respectful treatment, participation in care, privacy, confidentiality, access to records, complaints, and freedom from retaliation.

When applicable, Zalfi will provide a separate Consumer Rights Statement and Acknowledgment. Staff will explain those rights in understandable language and document that the written statement was provided and explained.

Signing this Consent does not waive any right provided by federal or Indiana law.

Complaints

You may raise a concern or complaint without retaliation. You may speak with your Provider or contact Zalfi directly:

Zalfi LLC
821 N State Road 135
Greenwood, Indiana 46142
Phone: 317-296-7707
Email: contact@zalfi.org

You may also contact an applicable professional licensing board, health plan, the Indiana Division of Mental Health and Addiction, or another agency with jurisdiction over the concern.

Privacy complaints may be submitted to the U.S. Department of Health and Human Services Office for Civil Rights:

Zalfi will not retaliate against you for making a good-faith complaint, exercising a legal right, or contacting an appropriate outside agency.

Changes to This Consent

Zalfi may revise this Consent when its services, policies, or legal obligations change. The current version will be available from Zalfi and may be posted at www.zalfi.org.

If a revision materially changes the services to which you previously consented, Zalfi may ask you to review and sign the revised Consent.

Emergency Information

Zalfi does not provide emergency services.

For an emergency: Call 911 or go to the nearest emergency department.

For suicide or crisis support: Call or text 988.

Acknowledgment and Consent

By signing below, I acknowledge and agree that:

  • I have read and understand this Consent for Treatment and Practice Policies.
  • I have had an opportunity to ask questions and have received answers that I understand.
  • I voluntarily consent to evaluation and treatment by Zalfi for the services specifically recommended and agreed upon.
  • I consent to receive clinically appropriate services through telehealth, subject to the limitations described above.
  • I understand that treatment outcomes cannot be guaranteed.
  • I understand that I may withdraw my consent to treatment or telehealth by notifying Zalfi, but withdrawal will not affect services already provided and may affect Zalfi’s ability to continue treating me safely.
  • I have received or been given electronic access to Zalfi’s current HIPAA and 42 CFR Part 2 Notice of Privacy Practices.
  • I understand that this Consent does not replace a separate Part 2 Consent for Use or Disclosure, Consumer Rights acknowledgment, IOP or group agreement, authorization for release of information, or treatment-plan signature when one is required.
  • I understand Zalfi’s general financial, cancellation, insurance, and record-copy policies.
  • I understand that signing this Consent does not waive any rights provided to me by law.

Website Privacy and Cookies

Last updated: September 24, 2026

This section explains what information zalfi.org collects when you visit the website. It does not cover your health records, which are described in the Notice of Privacy Practices above.

Website analytics. We use Google Analytics to understand how visitors use our website so we can improve it. It collects information such as:

  • the pages you visit
  • the website that referred you
  • your device and browser type
  • your general location (city or region)

It also records when someone clicks to book an appointment, call us or email us, or sends a message through our contact form. When a form is sent, only the fact that it was sent is recorded, never what you typed. We have turned off Google’s advertising and personalization features for this data.

Advertising measurement. We use Google Ads to let people know about our services. Our website tells Google Ads when a visit leads to a booking click, call or message, so we can see which ads are working. We do not use your visits to our website to show you personalized ads.

Cookies and browser storage. Google Analytics and Google Ads place small files called cookies in your browser to recognize repeat visits and measure ad results. Our site also saves two settings in your browser: your light or dark mode choice, and whether you have already closed our new-patient message. You can block or delete cookies in your browser settings. You can also opt out of Google Analytics on all websites with Google’s opt-out add-on: tools.google.com/dlpage/gaoptout.

Contact forms. Information you send through our contact or careers forms goes to Zalfi staff by email. Please do not include medical details. Call us instead at 317-296-7707.

Other websites. Links to TherapyPortal (booking and patient portal), Mind Metrix, social media and other sites are governed by those sites’ own privacy policies.

Questions. Contact our Privacy Officer at 317-296-7707 or contact@zalfi.org.

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