Your rights and our notices

HIPAA · 45 CFR 164.520 · 42 CFR Part 2 · RCW 70.02

Notice of Privacy Practices

How we may use and share your information

• Treatment. To provide and coordinate your care, including with pharmacies, labs and other clinicians treating you.
• Payment. To bill and collect for services. If you pay out of pocket in full, you can ask us not to share information with your health plan.
• Health care operations. To run the practice, review quality and meet licensing requirements.
• When the law requires or allows it. Including to prevent a serious and imminent threat to health or safety, to report suspected abuse or neglect, for health oversight, in response to a court order, and to the Washington Prescription Monitoring Program where required.

Uses that need your written permission

• Most uses and disclosures of psychotherapy notes.
• Marketing, and any sale of your information. Northform does not sell health information.
• Any other use not described in this notice. You may revoke permission in writing at any time.

Substance use disorder records

If you receive substance use disorder treatment, those records are also protected by federal law at 42 CFR Part 2. They will not be used or disclosed in any civil, criminal, administrative or legislative proceeding against you without your written consent or a court order that meets Part 2 requirements. With your single written consent, they may be used for treatment, payment and health care operations. You may request a list of disclosures made with your consent.

Reproductive and sensitive health information

We will not use or disclose information to investigate or penalize anyone for seeking, obtaining or providing lawful health care, as protected by federal and Washington law.

Your rights

• See and get a copy of your record, including an electronic copy. Washington law and HIPAA both give you this right.
• Ask us to correct information you believe is wrong or incomplete.
• Ask us to contact you in a specific way or at a specific address.
• Ask us to limit what we use or share.
• Get a list of certain disclosures we have made.
• Get a paper copy of this notice at any time.
• Choose someone to act for you, such as a health care agent or legal guardian.
• Be told if a breach compromises your unsecured health information.

Complaints

If you believe your privacy rights have been violated, contact Northform’s Privacy Officer, Mitchell Corbet, at [email protected]. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at hhs.gov/ocr/complaints or 1-800-368-1019, or with the Washington State Department of Health. You will not be retaliated against for filing a complaint.

We are required to protect your information, follow this notice and tell you if we change it. Changes apply to all information we hold, and the current notice will be posted here.

No Surprises Act · 45 CFR 149.610

Right to Receive a Good Faith Estimate of Expected Charges

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment and hospital fees.
• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.

Northform’s published rates are standard self-pay prices, not a Good Faith Estimate. Your individual written estimate is provided through the patient portal when you schedule.

Section 1557 · ADA · Washington Law Against Discrimination

Nondiscrimination statement

Northform complies with applicable federal and Washington civil rights laws and does not discriminate on the basis of race, color, national origin (including limited English proficiency and primary language), age, disability, sex (including sexual orientation, gender identity and sex characteristics), religion, creed, marital status, veteran or military status, or any other status protected by law. Northform does not exclude people or treat them differently because of these characteristics.

Northform provides, free of charge, reasonable modifications and appropriate auxiliary aids and services for people with disabilities, and language assistance, including qualified interpreters and written information in other languages.

To request these services, or if you believe Northform has discriminated against you, contact our Civil Rights Coordinator, Mitchell Corbet, at [email protected]. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at ocrportal.hhs.gov or 1-800-368-1019 (TDD 1-800-537-7697), or with the Washington State Human Rights Commission.

Language assistance · Ayuda con idiomas

Free language help

• English: ATTENTION: If you speak another language, free language assistance services are available to you. Email [email protected].
• Español: ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Escriba a [email protected]. El Sr. Corbet atiende consultas en español.
• Русский: ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Пишите на [email protected].
• Українська: УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки. Пишіть на [email protected].
• Tiếng Việt: CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gửi email đến [email protected].
• 中文: 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請發電郵至 [email protected]。
• 한국어: 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. [email protected] 로 이메일을 보내 주십시오.

ADA · WCAG 2.1 AA

Accessibility statement

Northform wants this website to be usable by everyone. We aim to meet the Web Content Accessibility Guidelines (WCAG) 2.1 Level AA, including keyboard navigation, text alternatives for images, readable contrast and support for reduced-motion settings.

If anything on this site is hard to use, or you need information in another format, contact [email protected], and we will help and fix the problem.

Washington telehealth

Telehealth visits

Northform offers video visits for patients who are physically located in Washington State at the time of the visit. Visits use a secure, HIPAA-compliant video platform. Before your first telehealth visit, you will review and sign a telehealth informed consent in the patient portal, which explains how virtual care works, its benefits and limits, privacy safeguards, and what happens if the connection fails or an emergency arises.

Controlled medications, including ADHD medications, are prescribed only as allowed by current federal (DEA) and Washington rules, which may require an in-person visit.

Terms of use

Using this website

• Content on this site is general education, not medical advice, diagnosis or treatment.
• Using this site, calling or emailing Northform does not create a patient–provider relationship. That begins only after intake is completed and accepted.
• Do not use this site or email for emergencies. Call 911 or call or text 988.
• Scheduling, intake forms and messages are handled in a secure patient portal operated by PracticeQ under a business associate agreement. This website itself does not collect or store health information.
• Mitchell Corbet, PMHNP-BC, is a board-certified Psychiatric Mental Health Nurse Practitioner licensed in Washington as an Advanced Registered Nurse Practitioner (ARNP), license ARNP.AP.70175312-NP (active since September 9, 2026), NPI 1861211674. You can verify any Washington health care license at the Department of Health provider credential search.
• Supplements and herbal therapeutics discussed on this site have not been evaluated by the FDA to diagnose, treat, cure or prevent any disease, and are recommended only as part of an individual treatment plan.