Terms and Conditions

Effective Date: 08/10/2026 Last Updated: 08/10/2026

 Appointments and Cancellations

Appointments are scheduled in advance, at a cadence we agree on, based on your goals, treatment needs, and our mutual availability. Cash paying customers will be charged following their appointment using the payment source you have provided to us. We must have a debit/credit card on file before the first appointment, as well as a credit card authorization form. Insurance charges for each appointment will be made through Headway after verifying qualifying insurance plans. Unity does NOT collect insurance copays. This is done by your insurance company and we have no control over the amount they charge. This copay can be up to $260 per session. While we make every attempt to help you understand your copay amount, it is not always possible for us. Please take time to know what your copay is before your appointment

You may cancel appointments up to 12 hours in advance without charge. For appointment no-shows, we charge a $75.00 fee, for last-minute cancellations which occur within 12 hours of the appointment, you will be charged a fee of $35.00. Multiple failures to show will result in Unity severing the care so we may focus on those that are in greater need. Please reach out to me directly for our latest policy on the cancellation cutoff period and fees, as Unity is unable to reimburse any portion of this.

In the event that we are unable to bill you for cash pay, or your insurance copay does not clear, we will be unable to schedule or provide medication refills until all past fees have been collected. Should this become a recurring issue, we will need to successfully bill your session in advance, up to 3 days prior. We pride ourselves on being extremely forgiving and give grace as much as we can, but we are still a business. Please provide us with the same grace we will always give you so we can seamlessly continue supporting you, as you deserve.

Patient based paperwork, such as workmen's comp, leave of absence, short/long-term disability, etc. will require an appropriate length appointment scheduled to complete and will be at no charge to you. Please keep in mind that the appointment to complete the paperwork must be 40-60 minutes in length in order to hold an evaluation, as well as completing paperwork. If you have paperwork that needs completed, please email to: Lets_talk@unitymhw.org, and then let us know immediately so we can adjust or move your next scheduled appointment to get both taken care of. A 20 minute appointment slot can not be used to complete paperwork, as there is simply not enough time for the actual appointment and completion of paperwork.

We check for texts and voice mail messages 24 hours a day and 7 days a week for the most part. If you are experiencing suicidal or homicidal thoughts, are in crisis, or need immediate help, please call 911 or go to the nearest emergency department.

As a small business, we use a third party company to bill the insurance company for us. This company is called Headway. We have used Headway for the past 3 years with great success, however, on occasion, there can be incorrect coverages provided by Headway. If there is any question regarding actual coverages and copays, please consult your insurance company directly. We will always take time to discuss what we see in regard to insurance coverages and copays, and will always be available to answer questions. If a situation arises where the amount discussed and the insurance copay charge are not the same, we will have Headway do a complete review of your policy, including calling your insurance company for correct coverage amounts. We will do everything possible to make sure that using your insurance will be stress free, but must also add that these situations do arise. We will work to resolve any discrepancies with you if needed.

Appointments with minors must also be attended by the parent. Please schedule accordingly with this is mind. This is for the safety of the child, especially if the child states they wish to do harm in any way, and the authorization in real time for any plan or medication charges by the parents. Please understand, if a minor shows up for an appointment without a parent being available, the appointment will marked as a no-show, possibly incurring a no-show fee, and will need to be rescheduled.

We are often not immediately available by telephone. We do not answer the phone when with clients or otherwise unavailable. At these times, it is suggested you text us at 480-676-9470 or you may leave a message on my confidential voicemail and I will return your call once I’ve reviewed your chart, but it may take a day or two for non-urgent matters. I will make every attempt to inform you in advance of planned absences, and provide you with the name and phone number of the mental health professional covering my practice. If I need to cancel an appointment at the last-minute, I will reach out as soon as possible and reschedule, or have a member of my staff connect with you.

There are several reasons why we may eventually end our professional relationship. You may decide you would prefer to work with a different provider. I may reach the conclusion you would be better served working with someone else. Regardless of the case, I will first discuss with you the reasons for discharging, and if you request, provide you with a list of other qualified providers. I will also extend the discharge process length if necessary based on your treatment needs, including continuing to provide emergency support for a time-limited period after you have been notified of the end of our treatment relationship.

Please note that ongoing failure to pay for treatment, attend sessions, or communicate with me in a respectful and timely manner can also result in discharge from my practice. In these instances, to ensure you have continued access to care, I will still make every reasonable effort to get in touch with you and provide referrals to a new provider before I consider our relationship ended.

Unity MHW wellness events are held outside of normal working hours and are considered voluntary for both provider/business and patient. Unity MHW LLC does NOT accept any responsibility for any type of injury that may happen at such events. Waivers from the host company, as well as a signed, paper waiver from Unity will be collected at each event. Please understand that attending these events is at your own risk.

• HIPPA Consent:

Our Notice of Privacy Practices provides information about how we may use and disclose protected health information about you. The Notice contains a Patient Rights section describing your rights under the law. You have the right to review our Notice before signing this Consent. The terms of our Notice may change, and if so, you may obtain a revised copy by contacting our office. You have the right to request that we restrict how protected health information about you is used or disclosed for treatment, payment or health care operations. We are not required to agree to this restriction, but if we do, we shall honor that agreement. By signing this form, you consent to our use and disclosure of protected health information about you for treatment, payment and health care operations. You have the right to revoke this Consent, in writing, signed by you. However, such a revocation shall not affect any disclosures we have already made in reliance on your prior Consent. The Practice provides this form to comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The patient understands that: Protected health information may be disclosed or used for treatment, payment or health care operations. All other disclosures by the practice will require specific authorization by you unless required by law. The Practice has a Notice of Privacy Practices and that the patient can review this Notice and receive a copy. The Practice reserves the right to change the Notice of Privacy Policies. The new policy will be posted in the lobby and on the web site. The patient has the right to restrict the uses of their information used for treatment, payment or operations, but the Practice does not have to agree to those restrictions.

• HIPAA AUTHORIZATION FOR USE OR DISCLOSURE OF HEALTH INFORMATION

THE PATIENT. This form is for use when such authorization is required and complies with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Standards.

 AUTHORIZATION. I authorize Unity Mental Health and Wellness LLC (“Authorized Party”) to request my medical records through Surescripts for medical use only.

PURPOSE. The reason for this authorization is general purpose in obtaining medical records and medication history, at the providers request.

ACKNOWLEDGMENT OF RIGHTS.

I understand that I have the right to revoke this authorization, in writing and at any time, except where uses or disclosures have already been made based upon my original permission. I might not be able to revoke this authorization if its purpose was to obtain insurance.

I understand that uses and disclosures already made based upon my original permission cannot be taken back.

I understand that it is possible that Medical Records and information used or disclosed with my permission may be re-disclosed by a recipient and no longer protected by the HIPAA Privacy Standards.

I understand that treatment by any party may not be conditioned upon my signing of this authorization (unless treatment is sought only to create Medical Records for a third party or to take part in a research study) and that I may have the right to refuse to sign this authorization.

• INFORMED CONSENT FOR TELEMEDICINE SERVICES

Telemedicine involves the use of electronic communications to enable health care providers at different locations to share individual patient medical information for the purpose of improving patient care. Providers may include primary care practitioners, specialists, and/or subspecialists. The information may be used for diagnosis, therapy, follow-up and/or education, and may include any of the following:

• Patient medical records
• Medical images
• Live two-way audio and video
• Output data from medical devices and sound and video files

Electronic systems used will incorporate network and software security protocols to protect the confidentiality of patient identification and imaging data and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.

• Improved access to medical care by enabling a patient to remain in his/her office (or at a remote site) while the physician obtains test results and consults from healthcare practitioners at distant/other sites.
• More efficient medical evaluation and management.
• Obtaining expertise of a distant specialist.

As with any medical procedure, there are potential risks associated with the use of telemedicine. These risks include, but may not be limited to:

• In rare cases, information transmitted may not be sufficient (e.g. poor resolution of images) to allow for appropriate medical decision making by the physician and consultant(s);
• Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment;
• In very rare instances, security protocols could fail, causing a breach of privacy of personal medical information;
• In rare cases, a lack of access to complete medical records may result in adverse drug interactions or allergic reaction or other judgment error.

BY SIGNING THIS FORM, I ATTEST TO AND UNDERSTAND THE FOLLOWING:

1. I understand that the laws that protect privacy and the confidentiality of medical information also apply to telemedicine, and that no information obtained in the use of telemedicine which identifies me will be disclosed to researchers or other entities without my consent,
2. I understand that I have the right to withhold or withdraw my consent to the use of telemedicine in the course of my care at any time, without affecting my right to future care or treatment,
3. I understand that I have the right to inspect all information obtained and recorded in the course of telemedicine interaction, and may receive copies of this information for a reasonable fee,
4. I understand that a variety of alternative methods of medical care may be available to me, and that I may choose one or more of these at any time. Erin Kloster, PMHNP-BC has explained the alternatives to my satisfaction,
5. I understand that telemedicine may involve electronic communication of my personal medical information to other medical practitioners who may be located in other areas, including out of state.
6. I understand that it is my duty to inform Erin Kloster, PMHNP-BC of electronic interactions regarding my care that I may have with other healthcare providers.
7. I understand that I may expect the anticipated benefits from the use of telemedicine in my care, but that no results can be guaranteed or assured.
8. I attest that I am located in the state of California and will be present in the state of Arizona or Colorado during all telehealth encounters with Erin Kloster PMHNP-BC.

• PATIENT CONSENT TO THE USE OF TELEMEDICINE

I have read and understand the information provided above regarding telemedicine, have discussed it with my physician or such assistants as may be designated, and all of my questions have been answered to my satisfaction. I hereby give my informed consent for the use of telemedicine in my medical care.

If you have questions about this Privacy Policy or our data practices, please contact us:

Michael and Erin Kloster, Unity Mental Health and Wellness @Lets_talk@Unitymhw.org or by voice/text at 480-676-9470 

Effective Date: 08/10/2026 Last Updated: 08/10/2026

Unity Mental Health and Wellness ("we," "us," or "our") respects your privacy and is committed to protecting the personal information you share with us. This Privacy Policy explains what information we collect, how we use it, who we share it with, and the choices you have. By using our website [Website URL] (the "Site") or our services, you agree to the terms of this Privacy Policy.

We may collect the following categories of personal information:

• Contact information: name, mailing address, email address, phone number
• Account information: username, password, and account preferences (if you create an account)
• Communication data: information you provide when you contact us, submit a form, sign up for a newsletter, or request customer support
• SMS/text messaging information: your mobile phone number and consent status when you opt in to receive text messages from us
• Payment information: billing address and payment details (processed securely through our payment processor; we do not store full card numbers)

We collect this information directly from you (e.g., when you fill out a form), automatically through your use of the Site, and in some cases from third parties (e.g., analytics or marketing partners).

We use the personal information we collect to:

• Provide, operate, and maintain our services, including coordination of care with other providers that is only necessary to continue proper care.
• Respond to inquiries, provide customer support, and fulfill requests
• Send transactional messages, including confirmations and account updates
• Send you SMS/text messages you have opted in to receive, such as appointment reminders, scheduling questions, onboarding, or account alerts
• Send marketing and promotional communications, where you have consented to receive them
• Improve and personalize the Site and our services
• Detect, prevent, and address fraud, security, or technical issues
• Comply with legal obligations and enforce our terms

We do not sell your personal information. We may share your personal information in the following limited circumstances:

• Service providers: With medical providers who perform services on our behalf (e.g., payment processing, hosting, email delivery, analytics), under contractual obligations to protect your information
• Legal and safety reasons: When required by law, regulation, legal process, or government request, or to protect the rights, property, or safety of our company, our users, or others
• Business transfers: In connection with a merger, acquisition, financing, or sale of company assets, subject to standard confidentiality arrangements
• With your consent: When you have given us explicit permission to share your information for a specific purpose

SMS consent and mobile phone numbers collected for text messaging purposes are not shared with third parties or affiliates for marketing or promotional purposes. Text messaging originator opt-in data and consent will not be shared with any third party.

• SMS opt-out: You may opt out of receiving text messages at any time by replying "STOP" to any message we send, or by contacting us at 480-676-9470.
• Email opt-out: You may unsubscribe from marketing emails using the unsubscribe link included in each message.
• Access and correction: You may request access to, correction of, or deletion of your personal information by contacting us at Lets_talk@UnityMHW.org
• Do Not Track / Cookie preferences: 
• State-specific rights: Depending on your state of residence, you may have additional rights under laws such as the California Consumer Privacy Act (CCPA) or other applicable state privacy laws. 

We retain personal information for as long as necessary to fulfill the purposes described in this Privacy Policy, unless a longer retention period is required or permitted by law.

We implement reasonable administrative, technical, and physical safeguards designed to protect your personal information. However, no method of transmission or storage is 100% secure.

Our Site and services are not directed to children under the age of 13 (or 16, where applicable), and we do not knowingly collect personal information from children.

We may update this Privacy Policy from time to time. Any changes will be posted on this page with an updated "Last Updated" date. Your continued use of the Site after changes are posted constitutes acceptance of the updated policy.

If you have questions about this Privacy Policy or our data practices, please contact us:

Michael and Erin Kloster, Unity Mental Health and Wellness @Lets_talk@Unitymhw.org or by voice/text at 480-676-9470