Confidentiality & Client Rights

All Clients Need To Read and Sign This Form Before Proceeding With The Full Intake Process

Welcome to The Heights:

We are glad you are here! Your safety is our highest priority and we respect you as an individual. Therefore, as you begin your journey with us, please know that we are here to help you achieve your goals. The information you share with The Heights, including your name, address, phone number, and other personal information, will not be shared with other agencies without your permission. Some information about clients at The Heights must be shared with the agencies that fund The Heights, but information that specifically could identify you as someone who receives services here will not be shared.

Limits of Confidentiality:

The Heights will keep your information confidential to the greatest extent allowed by the law. There are some legal and ethical exceptions to confidentiality. There are some things that The Heights staff is required to report even if you don’t give permission to report them. Those things are suspected child abuse or neglect, suspected abuse or neglect of an elderly or disabled adult, or threats to hurt yourself or others. If there is evidence of clear and imminent danger or harm to you and/or others, staff is required to report this information to the authorities responsible for ensuring your safety and the safety of others. If subpoenaed by a court of law, we may be required to release your records. The Heights will not release your information without your permission. If you do choose to access services with one of our partner agencies they may have additional confidentiality forms for you to complete and may have different policies concerning confidentiality.

High Risk Case Review:

The Heights we conduct regular high risk case review meetings involving the agencies that are The Heights partners. If you are identified as being at high risk, as determined by your danger assessment score or other means your case may be discussed in order to ensure that we are meeting all of your needs. If you do not wish for your case to be discussed with our partner agencies, please inform your intake specialist at this time.

Research Data:

The Heights partners with local colleges and universities to conduct research in our mission of helping victims become survivors with a thriving, safe, & healthy future. Your identifying information such as name, address, etc. will never be used without your written permission however non-identifying information may be used for research purposes.

Confidentiality Agreement:

For the safety and privacy of those using the services at The Heights, I agree not to disclose to anyone the names, descriptions, or any information regarding an individual I may learn about at The Heights.

Childcare Release:

If you have children we pledge to take care of them with great safety and concern during your time at The Heights. Please let us know of any special information like medical needs or food allergies.

Client Concerns:

If you have any questions or concerns about your rights, or if you have a concern that your confidential information was not treated appropriately, please contact the Service Director at 469.846.1304.

Client Signature:

By typing your name below, you are acknowledging that you have received and understand your client rights, limits of confidentiality,as well as the confidentiality agreement. Your typed name here serves as your legal signature.