Notice of Privacy Practices
Third Nature Therapy
Third Nature Consulting LLC | 190 N 10th St, Suite 307, Brooklyn, NY 11211
THIS NOTICE DESCRIBES HOW MEDICAL AND MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Effective date: November 5, 2026
Last updated: November 5, 2026
Our Duties
We are required by law to maintain the privacy of your protected health information ("PHI"), to give you this notice of our legal duties and privacy practices, and to notify you if a breach of your unsecured PHI occurs. We must follow the terms of the notice currently in effect. We reserve the right to change this notice and to make the new notice apply to all PHI we maintain. If we change it, we will post the revised notice on our website and in our office and make copies available on request.
How We May Use and Disclose Your Information Without Your Authorization
Treatment
We may use and share your PHI to provide and coordinate your care. For example, your therapist may consult with another clinician in our practice or, for ketamine assisted therapy, coordinate with the independent prescribing medical provider you are referred to.
Payment
We may use and share your PHI to bill and collect payment for services. For example, we prepare a superbill containing diagnosis and service codes so that you can seek out-of-network reimbursement from your health plan. We may also send claims to your health plan.
Health care operations
We may use and share your PHI to run our practice, such as quality review, training and supervision of clinicians, licensing, legal and accounting services, and business management.
Business associates
We share PHI with vendors that perform services for us, such as our electronic health record and client portal, telehealth video platform and payment processor. They must sign an agreement to protect your PHI.
Appointment reminders
We may contact you by phone, email or text message to remind you of appointments or provide service-related information, unless you ask us to use another method.
Other uses and disclosures permitted or required by law
Subject to New York law, which in some cases is stricter than federal law, we may use or disclose PHI without your authorization:
When required by law.
To report suspected child abuse or neglect, or as otherwise required by mandated reporting laws.
To prevent or lessen a serious and imminent threat to the health or safety of you, another person or the public, consistent with our professional and legal duties.
For public health activities and health oversight activities, such as audits or licensing investigations.
In judicial and administrative proceedings, in response to a court order or as otherwise permitted by law.
For law enforcement purposes, as permitted by law.
To coroners, medical examiners and funeral directors.
For specialized government functions, such as military or national security, as permitted by law.
For workers' compensation, as authorized by law.
For research, only under conditions allowed by law.
Uses and Disclosures That Require Your Written Authorization
Psychotherapy notes. Most uses and disclosures of psychotherapy notes (a therapist's separate notes analyzing session conversations) require your written authorization, except as permitted by law.
Marketing. We will not use or disclose your PHI for marketing without your written authorization.
Sale of PHI. We will not sell your PHI without your written authorization.
Other uses. Other uses and disclosures not described in this notice will be made only with your written authorization.
You may revoke an authorization in writing at any time, except to the extent we have already relied on it.
Your Rights
Right to inspect and copy. You may request access to, or an electronic or paper copy of, your PHI. We may charge a reasonable, cost-based fee as allowed by federal and New York law. In limited circumstances we may deny access; you may ask for that denial to be reviewed.
Right to request amendment. If you believe your PHI is incorrect or incomplete, you may ask us in writing to amend it. We may deny the request in certain cases and will explain why in writing.
Right to an accounting of disclosures. You may request a list of certain disclosures we made of your PHI in the six years before your request, other than for treatment, payment, operations and certain other purposes. The first list in a 12-month period is free.
Right to request restrictions. You may ask us to limit how we use or share your PHI. We are not required to agree, except that we must agree not to share PHI with your health plan for payment or operations if you have paid for the service in full out of pocket and the disclosure is not otherwise required by law.
Right to request confidential communications. You may ask us to contact you in a specific way or at a specific location (for example, only by a certain phone number). We will accommodate reasonable requests.
Right to be notified of a breach. You will be notified if a breach compromises the privacy of your unsecured PHI.
Right to a paper copy of this notice. You may ask for a paper copy at any time, even if you agreed to receive it electronically.
Right to choose someone to act for you. If you have given someone health care power of attorney or they are your legal guardian, that person can exercise your rights.
To exercise any of these rights, contact our Privacy Officer below. We may ask that requests be made in writing.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us using the contact information below, or with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or at www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.
Contact Information
Privacy Officer: Julie Goldberg
Email: support@thirdnaturetherapy.com
Phone: +1 720-689-2706
Mail: 190 N 10th St, Suite 307, Brooklyn, NY 11211