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- Good Faith Estimate
- Forms, Letters & Administrative Documentation
- Refund Policy
- Prescriptions & Medication Management
- Electronic Communications & Response Times
- Pharmacy Issues & Prior Authorizations
- Laboratory & Diagnostic Result
- Minors & Adolescent Care Policy
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Terms & Policies
Last Updated: September 30, 2026
Welcome to Nora Wellness & Management. These Terms & Policies provide important information regarding use of this website, telehealth services, scheduling, communications, payments, prescriptions, and other practice policies.
By using this website or scheduling services with Nora Wellness & Management, you acknowledge that you have reviewed the applicable terms and policies below.
Website Information
Information provided on this website is intended for general educational and informational purposes. Website content is not a substitute for an individualized medical or psychiatric evaluation, diagnosis, or treatment.
Use of this website does not establish a provider-patient relationship with Nora Wellness & Management. A provider-patient relationship is established only after appropriate registration, consent, and acceptance for clinical services.
Telehealth & Clinical Services
Nora Wellness & Management currently provides telehealth services to eligible patients located in Washington State and may provide services in other jurisdictions where the treating provider is legally authorized to practice.
Patients must be physically located in a jurisdiction where the provider is legally authorized to provide care at the time of the appointment.
Telehealth involves the delivery of healthcare services through electronic communications and technology. Although telehealth provides convenient access to care, it may not be appropriate for every condition or situation.
Patients may be asked to confirm their identity and physical location at the beginning of an appointment.
When clinically appropriate, Nora Wellness & Management may recommend or require an in-person evaluation, vital-sign assessment, laboratory testing, diagnostic testing, emergency evaluation, or referral to another healthcare professional or facility.
Emergencies & Crisis Care
Nora Wellness & Management is an outpatient practice and does not provide emergency, crisis-response, continuous, after-hours, or 24-hour clinical services.
Electronic messages, appointment requests, portal messages, website forms, email, and voicemail should not be used for emergencies or concerns requiring an immediate response.
If you are experiencing a medical or psychiatric emergency, believe you may harm yourself or another person, or otherwise require immediate assistance, call 911 or go to the nearest emergency department.
For mental health or suicide crisis support in the United States, call or text 988 to reach the Suicide & Crisis Lifeline.
Do not wait for a response from Nora Wellness & Management when immediate evaluation or intervention is needed.
Appointments & Scheduling
Appointments are scheduled based on provider availability.
Patients are responsible for providing accurate contact, insurance, billing, and scheduling information and for attending appointments at the scheduled time.
Appointment availability displayed online may change and does not guarantee that a particular appointment will remain available until scheduling is completed.
Nora Wellness & Management currently conducts scheduled clinical appointments on Fridays. Appointment availability may change as the practice’s schedule changes.
Cancellation & No-Show Policy
We understand that unexpected circumstances can arise. If you need to cancel or reschedule an appointment, please provide at least 48 hours’ notice.
Providing adequate notice allows the appointment time to be offered to another patient who may be waiting for care.
Late Cancellations
Appointments cancelled or rescheduled with less than 48 hours’ notice are considered late cancellations.
When permitted by applicable law and payer requirements, the following fees may apply:
- Initial evaluation: $120
- Follow-up appointment: $100
No-Shows
An appointment is considered a no-show when a patient does not attend the scheduled appointment and has not provided appropriate advance notice.
When permitted by applicable law and payer requirements, the following fees may apply:
- Initial evaluation: Full Session Fee
- Follow-up appointment: Full Session Fee
Late Arrival
Patients are expected to join telehealth appointments at their scheduled appointment time.
Patients arriving 10 minutes late may still be seen when sufficient appointment time remains. The visit may be shortened to avoid interfering with other scheduled appointments.
Patients who are 15 minutes or more late will generally be considered a no-show and will need to reschedule.
An exception may be made when the patient notifies Nora Wellness & Management in advance of the delay and the late arrival is approved. Approval depends on provider availability and whether sufficient time remains to provide appropriate clinical care.
If the appointment is classified as a no-show, the applicable no-show fee may be assessed.
Payment Required Before Rescheduling
When a late-cancellation or no-show fee is assessed, the outstanding balance must generally be paid in full before another appointment can be scheduled.
Exceptions may be made when required by applicable law or payer requirements or when necessary to address continuity of care or other clinical considerations.
Emergencies & Exceptions
Emergencies, acute illness, technology failures, and other unexpected circumstances may occur.
Nora Wellness & Management may waive a late-cancellation or no-show fee when circumstances reasonably warrant an exception.
Waivers are determined individually and are not guaranteed.
Repeated Missed Appointments
Repeated late cancellations, no-shows, or patterns of missed appointments may affect a patient’s ability to continue scheduling services with Nora Wellness & Management.
When appropriate, the practice will consider barriers to attendance, continuity of care, clinical needs, and applicable legal and payer requirements before making changes to ongoing care.
Insurance & Patient Responsibility
Late-cancellation and no-show fees are generally not billable to insurance and, when applicable, are the patient’s responsibility.
Fees will be assessed only when permitted by applicable law, payer requirements, and the patient’s applicable financial agreement.
Insurance, Self-Pay & Payment
Nora Wellness & Management may participate with selected insurance plans and may also offer self-pay services.
Insurance participation does not guarantee coverage for a particular service.
Patients are responsible for understanding their insurance benefits, including:
- Deductibles
- Copayments
- Coinsurance
- Prior-authorization requirements
- Referral requirements
- Network restrictions
- Coverage limitations
- Excluded or non-covered services
- Out-of-network benefits, when applicable
Verification of benefits or an estimate of insurance coverage or patient responsibility is not a guarantee of payment by an insurance company.
Patients remain responsible for amounts properly assigned to them by their health plan or otherwise owed under applicable financial policies and payer requirements.
Self-Pay Rates
Nora Wellness & Management offers self-pay services to patients who choose not to use insurance, do not have insurance coverage, or receive services that are not covered by their health plan, when permitted by applicable requirements.
Current self-pay rates are:
| Service | Duration | Cash Price |
|---|---|---|
| Initial psychiatric evaluation | 60 Minutes | $329.99 |
| Brief psychiatric follow-up | 20 Minutes | $129.99 |
| Standard psychiatric follow-up | 30 Minutes | $159.99 |
| Extended psychiatric follow-up | 40 Minutes | $229.99 |
| Comprehensive psychiatric follow-up | 60 Minutes | $299.99 |
| Initial standalone therapy assessment | 60 Minutes | $159.29 |
| Standalone psychotherapy | 50 Minutes | $139.29 |
These fees cover the professional services provided by Nora Wellness & Management during the appointment only.
Appointment fees do not include prescription medications, laboratory testing, imaging, pharmacy charges, or services provided by outside healthcare professionals, laboratories, pharmacies, imaging facilities, hospitals, or other third parties.
Such costs are separate and are the patient’s responsibility unless covered by insurance or another applicable benefit.
Nora Wellness & Management does not control or guarantee the prices charged by independent third parties or whether those charges will be covered by insurance.
Appointment Length
The appropriate appointment type and duration are determined based on the patient’s clinical needs and the services required.
A brief follow-up may be appropriate for an established patient with stable symptoms, routine medication monitoring, or a limited concern.
A brief appointment may not be appropriate when there are medication changes, multiple concerns, worsening symptoms, additional assessment needs, or more extensive treatment planning.
A standard or extended follow-up may be recommended when additional assessment, medication management, treatment planning, or clinical discussion is necessary.
Nora Wellness & Management may recommend a different appointment length when necessary to provide appropriate clinical care.
Choosing Insurance or Self-Pay
Patients who have health insurance may, when permitted by applicable law and payer requirements, choose either to:
- Use insurance and have Nora Wellness & Management submit eligible services to the patient’s health plan; or
- Elect self-pay and pay Nora Wellness & Management’s applicable self-pay rate without having a claim submitted to the patient’s health plan for that service.
Patients should notify Nora Wellness & Management of their payment choice before the applicable appointment or service is provided.
When a patient elects to use insurance, applicable deductibles, copayments, coinsurance, coverage limitations, authorization requirements, and other health-plan requirements may apply.
When a patient elects self-pay, the patient is responsible for the applicable self-pay charge regardless of whether the patient has insurance coverage.
Changing Between Insurance and Self-Pay
The patient’s payment election applies to the applicable appointment or service.
Once an appointment or service has been provided under the patient’s selected payment method, Nora Wellness & Management generally will not retroactively change that service from insurance billing to self-pay or from self-pay to insurance billing.
For example, a patient generally may not elect self-pay for an appointment, receive the self-pay rate, and later request that Nora Wellness & Management submit that same appointment to insurance.
Similarly, once a claim has been submitted and processed through insurance, the patient generally may not request that the completed service be converted to Nora Wellness & Management’s self-pay rate.
Exceptions may be made when necessary to correct a billing or administrative error or when otherwise required or permitted by applicable law, payer requirements, or Nora Wellness & Management’s contractual obligations.
A patient may request to change the payment method for future services, subject to applicable law, payer requirements, and practice policies.
Changing the payment method for future services does not automatically change how previously rendered services were billed.
Patients should discuss changes in payment preference with Nora Wellness & Management before the next appointment.
Self-Pay & Possible Insurance Reimbursement
If a patient chooses self-pay, Nora Wellness & Management does not guarantee that the patient’s insurance company will reimburse any portion of the self-pay charge.
When permitted and appropriate, Nora Wellness & Management may provide documentation that a patient can independently submit to an insurer for possible out-of-network reimbursement.
Providing documentation does not guarantee reimbursement.
Patients are responsible for determining whether their health plan permits reimbursement for self-paid or out-of-network services.
Good Faith Estimate
Your Right to Receive a Good Faith Estimate
Under the federal No Surprises Act, patients who do not have health insurance or who choose not to use their health insurance to pay for applicable healthcare services generally have the right to receive a Good Faith Estimate explaining the expected cost of their care.
A Good Faith Estimate provides an estimate of charges that Nora Wellness & Management reasonably expects for scheduled or requested healthcare services based on information available when the estimate is prepared.
A Good Faith Estimate is not a bill and does not require payment at the time the estimate is provided.
Who May Receive a Good Faith Estimate
You may be eligible for a Good Faith Estimate if you:
- Do not have health insurance; or
- Have health insurance but choose not to use that insurance to pay for the applicable healthcare service.
You may also request a Good Faith Estimate before scheduling a service.
When You Will Receive an Estimate
When required by applicable federal law:
- If a service is scheduled 3–9 business days in advance, the Good Faith Estimate will generally be provided within 1 business day after scheduling.
- If a service is scheduled 10 or more business days in advance, the Good Faith Estimate will generally be provided within 3 business days after scheduling.
- If you request a Good Faith Estimate before scheduling care, it will generally be provided within 3 business days after the request.
What the Estimate Includes
The Good Faith Estimate will identify healthcare services and expected charges that Nora Wellness & Management reasonably anticipates providing based on information available when the estimate is prepared.
The estimate may change if treatment needs change or additional services become clinically necessary.
A Good Faith Estimate does not guarantee a particular diagnosis, medication, prescription, treatment plan, number of appointments, or clinical outcome.
Services From Other Providers
A Good Faith Estimate from Nora Wellness & Management generally reflects charges expected from Nora Wellness & Management.
Separate costs may be charged by pharmacies, laboratories, imaging facilities, hospitals, specialists, other healthcare professionals, or other third parties.
Charges from independent organizations may not be included in Nora Wellness & Management’s estimate when those services or charges are not reasonably known or are independently provided and billed.
Changes in Treatment
Actual services required during treatment may differ from those originally anticipated.
Additional appointments, laboratory testing, medication monitoring, diagnostic services, documentation, or other clinically appropriate services may result in additional charges.
When reasonably possible and required by applicable law, significant changes to anticipated services or charges will be addressed through an updated estimate or other appropriate notice.
If Your Bill Is Higher Than Your Estimate
If a bill from a healthcare provider or facility is at least $400 more than the Good Faith Estimate provided by that provider or facility, you may be eligible to use the federal Patient-Provider Dispute Resolution process.
Keep a copy of your Good Faith Estimate and compare it with bills you receive.
Eligibility, deadlines, and other requirements for the federal dispute process are determined under applicable federal law.
Additional information about Good Faith Estimates and patient-provider billing disputes is available through the Centers for Medicare & Medicaid Services (CMS).
Forms, Letters & Administrative Documentation
Completion of forms, letters, certifications, and other administrative documentation outside a scheduled appointment requires professional time for medical-record review, assessment of the request, completion of documentation, and, when applicable, communication with the requesting organization.
Current administrative documentation fees are:
- Simple form or brief letter — $50
- Employment, school, accommodation, return-to-work, or similar documentation — $100
- FMLA or leave-of-absence documentation — $150
- Disability or other complex documentation — $200
- Revisions, supplemental forms, or additional paperwork related to a previously completed request — $50–$100, depending on complexity
Administrative documentation fees cover the professional time required to review and complete the documentation. They do not include a clinical appointment when an evaluation is necessary.
Clinical Evaluation May Be Required
Some forms require a current clinical evaluation before they can be completed.
If an appointment is necessary to evaluate symptoms, functional limitations, treatment response, ability to work or attend school, requested accommodations, or other information required by the form, the applicable appointment fee will be charged separately from the documentation fee.
For example, completion of FMLA documentation may require both a clinical follow-up appointment and the applicable FMLA documentation fee.
Payment of a documentation fee does not guarantee approval or certification of requested leave, disability, accommodation, work restriction, school requirement, or another requested determination.
Documentation will reflect the provider’s independent clinical judgment and information reasonably supported by the patient’s medical record and evaluation.
Nora Wellness & Management may decline to complete documentation when:
- There is insufficient clinical information;
- The requested determination is outside the provider’s scope of practice;
- An adequate treatment relationship has not been established; or
- The requested statement cannot be clinically supported.
Documentation Turnaround Time
Standard documentation requests should be submitted with all required forms and information at least 7–10 business days before the requested deadline.
The turnaround period begins after Nora Wellness & Management receives the complete documentation request and all information reasonably necessary to complete it.
Incomplete forms, missing records, the need for a clinical appointment, or requests requiring clarification may delay completion.
Rush Documentation
When scheduling and clinical responsibilities permit, Nora Wellness & Management may accept requests for expedited completion within 3 business days.
An additional $75 rush fee may apply.
Payment of a rush fee does not guarantee completion within the requested timeframe.
Rush requests may be declined when adequate time is unavailable, required information is missing, a clinical evaluation is necessary, or the requested timeframe would not allow appropriate clinical review.
Employer, School & Third-Party Requirements
Patients are responsible for determining what documentation is required by their employer, school, licensing organization, disability administrator, insurance company, government agency, or other requesting organization and for providing the correct forms and submission instructions.
Nora Wellness & Management cannot guarantee that another organization will accept the documentation or approve the patient’s request.
Administrative documentation fees are generally not billed to insurance and are the patient’s responsibility unless otherwise required by applicable law or payer requirements.
Refund Policy
Completed Clinical Services
Fees for clinical services that have already been provided are generally non-refundable.
Payment covers professional services associated with the encounter, including clinical evaluation, assessment, treatment planning, documentation, and other services associated with the visit.
Payment for an appointment does not guarantee a particular:
- Diagnosis
- Medication
- Prescription
- Referral
- Treatment recommendation
- Clinical outcome
Dissatisfaction with a clinical recommendation or a decision not to prescribe a requested medication does not, by itself, qualify a completed service for a refund.
Payments Made in Error
If a patient is charged in error, charged more than once for the same service, or pays an amount later determined not to be owed, Nora Wellness & Management will review the account and issue an appropriate refund or account credit when warranted.
Cancelled Appointments
Refunds related to patient cancellations are governed by the Cancellation & No-Show Policy.
If Nora Wellness & Management cancels an appointment before services are provided, payment collected specifically for that appointment will be refunded or, with the patient’s agreement, applied toward a rescheduled appointment.
Payment Questions & Disputes
Patients with questions about a charge are encouraged to contact Nora Wellness & Management so the account can be reviewed and any billing error or misunderstanding can be addressed.
Prescriptions & Medication Management
Prescriptions are provided only when clinically appropriate and are based on the provider’s professional judgment, applicable laws, clinical standards, and the patient’s individual circumstances.
Scheduling or paying for an appointment does not guarantee that a particular medication will be prescribed, continued, changed, increased, decreased, or discontinued.
Certain medications may require additional evaluation, monitoring, laboratory testing, medical records, prescription-monitoring review, vital signs, or other clinical information before a prescribing decision can be made.
Prescription Refills
Patients should submit routine prescription refill requests at least 5 business days before the medication is expected to run out.
Patients are responsible for monitoring their medication supply and requesting refills sufficiently in advance.
Submitting a refill request does not guarantee that a prescription will be issued.
A refill request may require:
- A follow-up appointment
- Updated clinical information
- Laboratory testing
- Vital signs
- Medication monitoring
- Controlled-substance monitoring
- Updated records
- Other clinically appropriate information
Prescription refills are not guaranteed outside an established treatment plan or when required follow-up or monitoring has not been completed.
Urgent or emergency medication concerns should not be communicated solely through routine website, portal, email, or voicemail messaging.
Controlled Substance Policy
Nora Wellness & Management is committed to the safe, appropriate, and responsible prescribing of controlled substances.
Controlled medications may be considered only when clinically appropriate and when prescribing is consistent with applicable federal and state law, professional standards, and the provider’s clinical judgment.
Controlled Substances Are Not Guaranteed
Scheduling or completing an appointment does not guarantee that a controlled substance will be prescribed, continued, increased, or replaced.
A previous prescription from another healthcare professional does not obligate Nora Wellness & Management to continue the same medication, dose, or treatment plan.
Treatment recommendations are based on an independent clinical assessment, available medical records, diagnosis, treatment history, risks and benefits, and other clinically relevant information.
Payment for an appointment is payment for the professional evaluation and is not payment for a prescription.
Appointment fees are not refundable solely because a requested medication is not prescribed.
Evaluation Before Prescribing
Controlled medications generally require a comprehensive clinical evaluation before prescribing.
Additional information may be required, including:
- Previous medical or psychiatric records
- Prior medication history
- Pharmacy records
- Laboratory or diagnostic testing
- Vital signs
- Information from previous treating clinicians
- Prescription Monitoring Program information
- Other clinically relevant information
Nora Wellness & Management may postpone or decline controlled-substance prescribing until sufficient information is available to make a safe and clinically appropriate treatment decision.
Prescription Monitoring Program (PMP/PDMP)
Nora Wellness & Management may review applicable Prescription Monitoring Program (PMP/PDMP) information before initiating, renewing, or modifying controlled-substance treatment and periodically throughout treatment as clinically appropriate or required by law.
Prescription-monitoring information may be used to:
- Review controlled-substance prescribing history
- Identify potentially overlapping prescriptions
- Support medication reconciliation
- Assess medication safety
- Coordinate care
- Determine whether continued controlled-substance treatment remains appropriate
Patients are expected to provide accurate information regarding controlled medications prescribed by other healthcare professionals.
Controlled-Substance Monitoring
Patients receiving controlled substances may be required to participate in ongoing monitoring.
Monitoring may include, when clinically appropriate:
- Random urine drug screening or other toxicology testing
- PMP/PDMP review
- Medication or pill counts
- Pharmacy verification
- Review of medication fill history
- Review of relevant medical or pharmacy records
- Vital-sign monitoring
- Laboratory or diagnostic testing
- Verification of medications prescribed by other healthcare professionals
- More frequent follow-up appointments
- Controlled-substance treatment agreements
- Other monitoring considered clinically appropriate or required by law
Urine drug screening or other toxicology testing may be requested randomly or at clinically appropriate intervals.
Testing may be used to help assess medication adherence, medication safety, potential interactions, and the presence or absence of substances relevant to safe treatment.
Patients are expected to complete requested monitoring within the timeframe established by the provider.
Failure or refusal to complete clinically required monitoring may result in reassessment of whether a controlled substance can safely be prescribed or continued.
Unexpected Drug-Screen Results
If a urine drug screen or other toxicology test produces an unexpected result, Nora Wellness & Management may require additional evaluation before making significant treatment decisions.
Evaluation may include:
- Discussing the result with the patient
- Reviewing current and recently used medications
- Reviewing prescription and pharmacy history
- Reviewing the PMP/PDMP
- Considering the timing of the patient’s last medication dose
- Repeating the screening test
- Obtaining more specific confirmatory laboratory testing when clinically appropriate
- Obtaining other clinically relevant information
An unexpected screening result does not automatically establish medication misuse or inappropriate substance use. Screening tests may produce findings requiring clarification or confirmation.
When clinically appropriate, unexpected findings may therefore be confirmed or otherwise evaluated before significant treatment decisions are made.
Confirmed results or other reliable clinical information indicating medication misuse, unsafe medication combinations, diversion, undisclosed controlled-substance use, or another significant safety concern may result in:
- Increased monitoring
- Modification of the treatment plan
- Discontinuation or non-renewal of a controlled medication
- Referral for additional evaluation or treatment
Cost of Monitoring
The cost of urine drug screening, confirmatory testing, laboratory testing, medications, pharmacy services, diagnostic testing, or other third-party services is not included in Nora Wellness & Management’s appointment fees.
Patients may be responsible for these costs when they are not covered by insurance or another applicable benefit.
Controlled-Substance Treatment Agreement
Patients receiving certain controlled medications may be required to review and sign a separate controlled-substance or medication-management agreement.
Continued prescribing may depend on adherence to monitoring, follow-up, and medication-safety requirements established in that agreement.
One Prescriber & Pharmacy Coordination
When clinically appropriate, patients receiving ongoing controlled-substance treatment may be asked to obtain the applicable controlled medication from one prescribing clinician or coordinated treatment team and use one pharmacy whenever reasonably possible.
Patients must inform Nora Wellness & Management of controlled medications prescribed by other healthcare professionals.
Controlled-Substance Refills
Controlled-substance refill requests should generally be submitted at least 5 business days before the medication is expected to run out.
A refill request does not guarantee that a prescription will be issued.
A follow-up appointment, required monitoring, updated records, laboratory testing, or additional clinical information may be required before medication is renewed.
Controlled medications will not routinely be refilled outside the established treatment and follow-up plan.
Early Refills, Lost or Stolen Medication
Early refills of controlled substances are generally not provided.
Requests involving medication that is lost, stolen, damaged, misplaced, or used sooner than prescribed will be reviewed individually and do not guarantee replacement or an early prescription.
Supporting documentation may be requested when appropriate.
Patients are responsible for storing controlled medications securely and taking them only as prescribed.
Dose Changes
Patients should not independently increase, decrease, share, combine, or otherwise change how a controlled medication is taken unless instructed by an appropriate healthcare professional.
Requests for dose increases or significant medication changes may require a follow-up appointment.
Telehealth Prescribing
Controlled substances may be prescribed through telehealth only when permitted by applicable federal and state requirements and when the provider determines that telehealth prescribing is clinically appropriate.
An in-person evaluation may be required before starting or continuing a controlled medication when required by law, professional standards, payer requirements, or the provider’s clinical judgment.
If an appropriate in-person evaluation, laboratory test, toxicology screen, vital-sign assessment, or other monitoring cannot be completed through Nora Wellness & Management, the patient may be required to complete the requested service through an appropriate local healthcare professional, laboratory, or facility.
Medication Safety
Patients must take controlled medications only as prescribed and must not sell, share, transfer, or provide medication to another person.
Patients should notify Nora Wellness & Management of medications and substances they are taking when relevant to safe prescribing, including controlled medications prescribed by another healthcare professional.
Patients should seek immediate medical attention for a suspected overdose, severe medication reaction, or other medical emergency.
Concerning Medication Use
Controlled-substance treatment may be reassessed when concerns arise regarding:
- Medication safety
- Medication misuse
- Diversion
- Unexpected or inconsistent monitoring results
- Overlapping controlled-substance prescriptions without appropriate coordination
- Repeated early-refill requests
- Failure or refusal to complete required monitoring
- Significant inconsistencies in medication or prescription history
- Other circumstances raising clinically significant safety concerns
When clinically appropriate, Nora Wellness & Management may increase monitoring, modify the treatment plan, recommend alternative medication, decline to prescribe or renew a controlled substance, or refer the patient for a different level or type of care.
Changes to controlled-substance prescribing do not necessarily mean that all care with Nora Wellness & Management will be discontinued.
Treatment Decisions
Nora Wellness & Management may decline to initiate or continue a controlled medication when the provider determines that the medication is not clinically appropriate or cannot be prescribed safely or legally.
When appropriate, alternative treatments, additional evaluation, referral, or other treatment options may be discussed.
This policy does not replace individualized clinical judgment or applicable federal and state prescribing requirements.
Electronic Communications & Response Times
Nora Wellness & Management may communicate with patients through approved electronic systems, including patient portals, telephone, text messaging, email, and telehealth technology.
Electronic communications carry privacy and technology risks.
Patients should avoid sending sensitive health information through communication methods that have not been designated for clinical communication.
Clinical questions, medication concerns, and protected health information should be communicated using methods designated by the practice.
Practice Schedule
Nora Wellness & Management currently conducts scheduled clinical appointments on Fridays.
Routine administrative and electronic communications may be reviewed periodically outside scheduled clinical hours.
Availability outside scheduled appointment hours does not constitute continuous or on-call clinical coverage.
Electronic Message Response Time
Routine, non-urgent electronic messages are generally responded to within 3 business days.
This includes non-urgent messages submitted through the patient portal or another electronic communication method designated by Nora Wellness & Management.
Messages received on weekends or recognized holidays will generally be considered received on the next business day.
Response times may occasionally be longer because of provider absence, holidays, unusually high message volume, the need for medical-record review, or circumstances requiring additional clinical review.
Electronic messaging should not be used for urgent or emergency concerns.
Clinical Questions by Message
Electronic messaging is intended for brief, non-urgent questions and administrative communication.
Concerns requiring clinical assessment, medication changes, extensive medical decision-making, discussion of multiple concerns, or significant provider time may require an appointment.
Electronic messaging is not a substitute for a clinical appointment when an evaluation is necessary.
Appropriate Use of Messaging
Patients should use the secure patient portal or another communication method designated by Nora Wellness & Management for clinical questions and protected health information whenever possible.
Email, social media, website contact forms, and other non-secure communication channels should not be used for detailed clinical concerns or emergencies.
Repeated, lengthy, or clinically complex discussions through messaging may require a scheduled appointment.
Response-Time Limitations
Response-time estimates reflect typical practice expectations and are not guarantees.
Nora Wellness & Management’s Friday clinical schedule does not mean that the practice provides continuous clinical availability throughout the remainder of the week.
Patients should use appropriate urgent, emergency, or community healthcare resources when their needs cannot safely wait for a response from the practice.
Pharmacy Issues & Prior Authorizations
Medication shortages, pharmacy inventory, insurance requirements, prior authorizations, pharmacy processing delays, and other circumstances outside the practice’s control may delay access to medication.
Nora Wellness & Management will make reasonable efforts to address pharmacy and prior-authorization requests. However, the practice cannot guarantee medication availability, insurance approval, or third-party processing times.
Laboratory & Diagnostic Results
Laboratory and diagnostic results are reviewed as they become available.
Patients will generally be contacted regarding results requiring clinical follow-up.
Some results may require a scheduled appointment so findings, treatment options, and next steps can be appropriately discussed.
Patients should not wait for a routine electronic response when experiencing potentially serious or rapidly worsening symptoms.
Minors & Adolescent Care Policy
Nora Wellness & Management may provide outpatient mental health services to minors and adolescents when clinically appropriate and permitted by applicable Washington State and federal law.
Consent for Treatment
Consent requirements for minors depend on the patient’s age, type of service, and applicable law.
In Washington State, adolescents 13 years of age and older may generally request and receive their own outpatient behavioral health treatment without the consent of a parent or legal guardian.
For patients under age 13, authorization from a parent, legal guardian, or another person legally authorized to consent on behalf of the minor is generally required.
Washington law also provides circumstances in which a parent or guardian may initiate behavioral health evaluation or treatment for an adolescent.
Nora Wellness & Management will follow applicable consent requirements based on the circumstances of each patient’s care.
Parent or Guardian Participation
Nora Wellness & Management recognizes that parents and guardians can play an important role in supporting a minor’s treatment.
When appropriate and legally permitted, parents or guardians may participate in treatment planning, provide relevant medical or developmental history, assist with medication management, and support treatment recommendations.
Parental participation and access to information may be limited when the minor has legal authority to consent independently to confidential services.
Adolescent Confidentiality
Adolescent patients are entitled to confidentiality consistent with applicable Washington State and federal law.
When an adolescent is legally authorized to consent to their own care, information regarding that care may be protected from disclosure to a parent or guardian unless the adolescent authorizes disclosure or disclosure is otherwise permitted or required by law.
Whenever appropriate, Nora Wellness & Management encourages healthy communication between adolescents and their parents or caregivers while respecting the adolescent’s legal confidentiality rights.
Private Time During Appointments
Adolescent appointments may include a portion of the visit conducted privately between the patient and provider.
Private discussion allows adolescents to speak openly about symptoms, medications, relationships, substance use, safety concerns, and other sensitive health matters.
Parents and guardians should understand that private provider-patient communication is a routine component of adolescent healthcare and does not necessarily indicate that information is being intentionally withheld from the family.
Limits of Confidentiality
Confidentiality is not absolute.
Information may be disclosed when required or permitted by law, including circumstances involving suspected abuse or neglect, serious safety concerns, threats of harm to the patient or others, medical emergencies, court orders, or other legally required disclosures.
The provider will explain relevant confidentiality expectations and limitations to the adolescent and, when appropriate, the parent or guardian.
Telehealth With Minors
Minor and adolescent patients receiving telehealth services must be physically located in a jurisdiction where the provider is legally authorized to provide care at the time of the appointment.
At the beginning of a telehealth appointment, Nora Wellness & Management may verify the patient’s identity, physical location, privacy, emergency contact information, and other information necessary for safe telehealth care.
When clinically appropriate, the provider may request that a parent, guardian, or responsible adult be available during or immediately following an appointment, particularly when safety concerns, medication management, or other clinical circumstances warrant additional support.
Patient Portal, Proxy Access & Electronic Communications
Access to a minor patient’s portal, appointment information, clinical documentation, prescriptions, test results, billing information, and electronic communications will be managed according to applicable privacy and minor-consent requirements.
A parent or guardian will not automatically be provided unrestricted access to all of a minor patient’s health information solely because the patient is under 18.
Portal and proxy access may depend on:
- The patient’s age
- The type of healthcare services received
- Who consented to the services
- The legal authority of the parent or guardian
- Applicable Washington State and federal confidentiality requirements
When an adolescent has independently consented to legally confidential services, Nora Wellness & Management may restrict parental or guardian access to information associated with those services unless the adolescent authorizes disclosure or disclosure is otherwise permitted or required by law.
Nora Wellness & Management may request documentation establishing parental rights, guardianship, custody, healthcare decision-making authority, or other legal authority before granting access to a minor patient’s information.
Patients, parents, and guardians should not share portal usernames or passwords.
When available, authorized parents or guardians should use appropriate proxy or guardian access rather than accessing the patient’s account using the patient’s credentials.
Patients and families should understand that confidentiality may also be affected by systems outside Nora Wellness & Management’s direct control.
Insurance explanations of benefits (EOBs), pharmacy communications, prescription notifications, laboratory systems, electronic health records, billing systems, and other third-party communications may reveal that healthcare services were received.
Nora Wellness & Management will make reasonable efforts to protect confidential information but cannot guarantee the confidentiality practices or communications of independent insurers, pharmacies, laboratories, technology vendors, or other third parties.
Medication Management for Minors
Prescribing medication to a minor or adolescent is based on individualized clinical evaluation and the provider’s professional judgment.
An appointment does not guarantee that medication will be prescribed or that medication previously prescribed by another clinician will be continued.
When clinically appropriate, additional information may be required before prescribing, including:
- Medical records
- Medication history
- Laboratory testing
- Vital signs
- Pharmacy information
- Prescription Monitoring Program information
- Coordination with other healthcare professionals
Controlled medications are additionally subject to Nora Wellness & Management’s Controlled Substance Policy.
Safety & Emergencies
Nora Wellness & Management does not provide emergency or 24-hour crisis services.
If a minor or adolescent is experiencing a medical or psychiatric emergency, is at immediate risk of harming themselves or another person, or requires immediate evaluation, call 911 or go to the nearest emergency department.
Patients and families may also call or text 988 for the Suicide & Crisis Lifeline.
Individual Circumstances
Minor-consent, confidentiality, parental-access, and information-sharing requirements can vary depending on the patient’s age, services being provided, who consented to treatment, custody or guardianship arrangements, and other circumstances.
Nora Wellness & Management will follow applicable Washington State and federal requirements and may request additional documentation or clarification before providing treatment, releasing information, or granting portal access.
Privacy
Nora Wellness & Management respects the privacy of patient information and maintains privacy practices consistent with applicable legal and professional requirements.
The use and disclosure of protected health information are addressed separately in Nora Wellness & Management’s Notice of Privacy Practices.
Patients should review the Notice of Privacy Practices for additional information regarding privacy rights and the practice’s responsibilities.
Website Links & Third-Party Services
This website may contain links to third-party websites, scheduling systems, patient portals, payment services, laboratories, pharmacies, telehealth platforms, or other external resources.
Nora Wellness & Management does not control independent third-party websites or services and is not responsible for their content, availability, privacy practices, security practices, pricing, or terms of use.
Use of third-party services may be subject to separate terms, policies, and privacy practices.
Educational Content
Articles, resources, social media content, website information, and other educational materials provided by Nora Wellness & Management are intended for general education.
Educational materials should not be interpreted as individualized medical advice and should not be used as a substitute for professional evaluation, diagnosis, or treatment.
Respectful & Appropriate Use
Patients and website users are expected to communicate respectfully with practice personnel and use practice communication systems appropriately.
Threatening, abusive, fraudulent, harassing, or inappropriate use of practice systems may result in limitations on communication or other appropriate action consistent with applicable professional, ethical, continuity-of-care, and legal requirements.
Changes to These Terms & Policies
Nora Wellness & Management may periodically update these Terms & Policies to reflect changes in services, technology, practice operations, legal requirements, payer requirements, or other circumstances.
The current version will be posted on the Nora Wellness & Management website with the date of the most recent update.
Contact
Questions regarding these Terms & Policies, billing, Good Faith Estimates, or other practice policies may be directed to Nora Wellness & Management using the contact information provided on the practice website.
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