TERMS AND CONDITIONS
Last Updated: March 12, 2025
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By submitting your information through this website, you acknowledge and agree to the
following Terms of Service regarding communication, privacy, and data usage.
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1. PURPOSE OF FORM SUBMISSION
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This form is intended for individuals seeking more information about mental health services offered by Heidi V. Applegarth, LLC. Submission of this form does not establish a therapist-client relationship, nor does it guarantee service availability.
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2. INFORMATION COLLECTED
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When submitting this form, you voluntarily provide:
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• Your name
• Your phone number (optional but required for SMS communication)
• Your email address
• Any additional details you choose to share
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This information will be used solely for the purpose of responding to your inquiry and
scheduling an initial consultation if applicable.
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3. CONSENT TO ELECTRONIC COMMUNICATION (SMS & EMAIL)
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By providing your phone number and/or email, and checking included boxes you consent to receive non-clinical communication, including:
✅ Appointment inquiries and scheduling follow-ups
✅ General practice information
✅ Administrative responses
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You acknowledge that text messages and emails are not fully secure and should not be used for sharing confidential information. If you wish to discuss private matters, please contact our office by phone or request a secure communication method.
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3.1 SMS COMPLIANCE WITH THE CAMPAIGN REGISTRY (TCR)
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• By submitting this form with your phone number, and checking the box marked “accept” you authorize Heidi V. Applegarth, LLC to contact you via SMS for service-related inquiries.
• You may opt out at any time by replying “STOP” to any text message or contacting us directly.
• Standard message and data rates may apply, depending on your carrier.
• SMS messages are not used for marketing and are limited to service-related communication.
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4. DATA PRIVACY & COMPLIANCE WITH NEBRASKA LAW
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• Your information will not be shared, sold, or used for marketing purposes.
• Communications through this form are not encrypted, and submission is at your discretion.
• We comply with Nebraska state privacy laws regarding client confidentiality. However, submitting this form does not constitute a legally protected therapy relationship.
• If you become a client, additional consent forms regarding HIPAA-compliant communication will be required.
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5. OPTING OUT & REVOKING CONSENT
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• You can unsubscribe from SMS by replying "STOP" at any time.
• To stop receiving emails, please reply with "Unsubscribe" or contact us directly.
• Opting out of electronic communication will not affect your ability to seek services through other means (e.g., phone calls).
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6. NO EMERGENCY SERVICES
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This form is not monitored 24/7. If you are experiencing a mental health crisis, please call 911,
go to the nearest emergency room, or contact a crisis hotline such as:
📞 988 (National Suicide & Crisis Lifeline)
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7. CHANGES TO THESE TERMS​
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We may update these terms as needed. Continued use of this form implies acceptance of any
updates.​
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8. CONTACT US
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For any questions regarding these Terms of Service, please contact:
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Heidi V. Applegarth, LLC