Headspace Health, Inc.’s (“Headspace”) clinical care is provided by one of the nation’s leading provider groups, SteadyMD Physician Group, P.C. and its contractual affiliates. Headspace connects you to a SteadyMD therapist to determine a diagnosis and develop a personalized treatment plan during your initial consultation. Headspace does not provide any behavioral health services, does not practice medicine, and does not influence the practice of medicine or any other licensed profession provided by SteadyMD’s providers, each of whom are responsible for his or her professional services and compliance with the requirements applicable to his or her profession and license.
This Patient Agreement (the “Agreement”), effective as of the date of your first visit (the “Effective Date”), is made by and between SteadyMD Physician Group, P.C., a Missouri professional corporation (the “Practice”), SteadyMD contractual affiliates and/or associates (“Affiliates”) and the undersigned patient (“You”).
You are a patient of the Practice who receives certain behavioral health services from the Practice using telehealth technologies (“Behavioral Health Services”). The purpose of this Agreement is to set forth the terms and conditions of how the Behavioral Health Services will be furnished to You by the Practice. You and the Practice therefore agree as follows.
This Agreement will commence on the Effective Date and will continue until you no longer are receiving Behavioral Health Services from SteadyMD. Patients are able to cancel with no penalty or obligation to continue. In order to process a cancellation, we ask the patient to provide us with an updated address to send their medical records and fill out a brief survey.
This Agreement and the provision of Behavioral Health Services on your behalf are not substitutes for health insurance or other health plan coverage (such as membership in an HMO). You acknowledge that the Practice has advised You to obtain or keep in full force your health insurance policy(ies) or plans in order to cover You and your family members for medical services and other healthcare costs. You acknowledge that this Agreement is not a contract that provides health insurance for you, and this Agreement is not intended to replace any insurance coverage provided to You by an insurer and that Behavioral Health Services are not intended to be billed to or covered by your Insurer.
If for any reason any provision of this Agreement shall be deemed, by a court of competent jurisdiction, to be legally invalid or unenforceable in any jurisdiction to which it applies, the validity of the remainder of the Agreement shall not be affected, and that provision shall be deemed modified to the minimum extent necessary to make that provision consistent with applicable law and in its modified form, and that provision shall then be enforceable.
You understand, agree and acknowledge that we may modify, suspend, disrupt or discontinue the SteadyMD platform, any part of the platform or the use of the platform, whether to all clients or to you specifically, at any time with or without notice to you. You agree and acknowledge that we will not be liable for any of the aforementioned actions or for any losses or damages that are caused by any of the aforementioned actions.
The SteadyMD platform depends on various factors such as software, hardware and tools, either our own or those owned and/or operated by our contractors and suppliers. While we make commercially reasonable efforts to ensure the platform’s reliability and accessibility, you understand and agree that no platform can be 100% reliable and accessible and so we cannot guarantee that access to the platform will be uninterrupted or that it will be accessible, consistent, timely or error-free at all times.
We may change this Agreement by posting modifications on the SteadyMD platform regarding the Behavioral Health Services. Unless otherwise specified by us, all modifications shall be effective upon posting. Therefore, you are encouraged to check the terms of this Agreement frequently. The last update to this Agreement is posted at the bottom of this Agreement. By using the SteadyMD platform and the Behavioral Health Services after the changes become effective, you agree to be bound by such changes to the Agreement. If you do not agree to the changes, you must terminate your access to the SteadyMD platform and participation in the Behavioral Health Services. Moreover, if federal, state, or local law or regulation (“Applicable Law”) requires this Agreement to contain provisions that are not expressly set forth in this Agreement, then, to the extent necessary, such provisions shall be incorporated by reference into this Agreement and shall be deemed a part of this Agreement as though they had been expressly set forth in this Agreement.
This Agreement, and any rights You may have under it, may not be assigned or transferred by You. This Agreement, and any rights the Practice may have under it, may not be assigned or transferred to its heirs, successors, or assignees. The Practice may freely transfer or assign this Agreement and/or any of its obligations hereunder.
You and the Practice intend and agree that the Practice, in performing the Behavioral Health Services under this Agreement, is an independent contractor, as defined by the guidelines promulgated by the United States Internal Revenue Service and/or the United States Department of Labor, and the Practice shall have exclusive control of its work and the manner in which it is performed.
You acknowledge that this Agreement is a legal document and creates certain rights and responsibilities. You also acknowledge that You have had a reasonable time to seek legal advice regarding the Agreement and have either chosen not to do so or have done so and are satisfied with the terms and conditions of the Agreement.
All written notices are deemed served when sent if sent to the e-mail address of the party.
This Agreement shall be governed and construed under the laws of Missouri. This Agreement shall be construed without regard to any presumptions or rules requiring construction against the party causing the instrument to be drafted.
Captions in this Agreement are used for convenience only and shall not limit, broaden, or qualify the text.
This Agreement contains the entire agreement between the parties regarding the subject matter of this Agreement, and supersedes all prior oral and written understandings and agreements regarding the subject matter of this Agreement. If any provision of this Agreement is held by a court of competent jurisdiction to be illegal, invalid, unenforceable, or otherwise contrary to law, the remaining provisions of this Agreement will remain in full force and effect.
Under the Agreement, you are entitled to receive the following Behavioral Health Services in exchange for the fee listed below:
You understand and agree that email and the internet should never be used to access medical care in the event of an emergency, or any situation that you could reasonably expect may develop into an emergency. You agree that in such situations, when you cannot speak to a therapist immediately in person or by telephone, that you shall call 911 or the nearest emergency medical assistance provider, and follow the directions of emergency medical personnel.
Teletherapy involves the use of electronic communications technologies to enable the transfer of medical/health and other information between a health care provider and patient who are in different locations. Teletherapy technologies may include interactive two-way audio and video, interactive audio, remote monitoring, patient medical records, medical images, e-mail, output data from medical devices, and sound and video files. Information conveyed using teletherapy may be used for the diagnosis, treatment, follow-up and/or education of patients.
Electronic systems incorporate network and software security protocols to protect your confidentiality and the confidentiality of your data. Our system also includes measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.
As with any medical procedure, there are potential risks associated with the use of teletherapy. These risks include, but may not be limited to:
All SteadyMD therapists hold professional licenses issued by the professional licensing boards in the states where they practice, hold masters or doctoral degrees in the particular profession, and have undergone the requisite training for that profession. You can report a complaint relating to Behavioral Health Services provided by a therapist by contacting the professional licensing board in the state where the Behavioral Health Services were received. In a professional relationship, sexual intimacy is never appropriate and should be reported to the appropriate board that licenses, registers, or certifies the licensee.
You can find the contact information for each state professional licensing board governing psychology on the Association of State and Provincial Psychology Boards website at
You can find the contact information for each state professional licensing board governing marital and family therapists on the American Association for Marriage and Family Therapy website at
You can find the contact information for each state professional licensing board governing professional counseling on the American Counseling Association website at
You can find the contact information for each state professional licensing board governing social workers on the Association of Social Worker Boards at
Any clinical records created as a result of the provision of Behavioral Health Services will be securely maintained by SteadyMD on behalf of your therapist for a period that is no less than the minimum number of years such records are required to be maintained under state and federal law
Please report any violations of these New Patient Agreement and Informed Consent to email@example.com.
The following are the SteadyMD Terms and Conditions for Behavioral Services, which govern your access and use of our online platform through which therapy may be provided (collectively, the "Platform"). The Platform may be provided or be accessible via multiple websites or applications whether owned and/or operated by us or by third parties, including, without limitation, the websites at care.headspace.com and steadymd.com, and related apps.
By accessing or using the Platform, you are entering into this Agreement. You should read this Agreement carefully before starting to use the Platform. If you do not agree to be bound to any term of this Agreement, you must not access the Platform.
When the terms "we", "us", "our" or similar are used in this Agreement, they refer to any company that is affiliated with, and/or owns and operates the Platform, including but not limited to SteadyMD Physician Group, P.C., and SteadyMD, Inc. (the "Company").
You hereby certify that you are (i) over the age of eighteen (18) or have the legal ability to consent to Behavioral Health Services (as defined below) or have your Parent/Guardian consent to Behavioral Health Services, and (ii) physically located and are a resident of the United States when creating your account and when attending a session. You agree to provide “Contact Information'' (your personal contact and/or a close family member/relation) to your Therapist (as defined below) to act as an information source to be used in case of a mental health crisis or other emergency where knowledge of your location is crucial. You acknowledge that your ability to access and use the Platform is conditioned upon the truthfulness of the information you provide regarding your age, residence and Contact Information and that the Theapists you access are relying upon this certification in order to interact with you and provide the Behavioral Health Services.
The Platform may be used to connect you with a therapist who will provide behavioral health services to you through the Platform (“Behavioral Health Services”).
We require every therapist providing Behavioral Health Services on the Platform to be an accredited, trained, and experienced licensed psychologist (PhD / PsyD), licensed marriage and family therapist (LMFT), licensed clinical social worker (LCSW), licensed professional counselor (LPC), or similar applicable recognized professional certification based on their state and/or jurisdiction (“Therapist”).
Therapists may be independent providers who are neither our employees nor agents nor representatives; alternatively, the Therapists may be employees of SteadyMD. The Platform’s role is limited to enabling the Behavioral Health Services while the provision of Behavioral Health Services is the responsibility of the Therapist who provides them.
While we hope the Behavioral Health Services are beneficial to you, you understand, agree and acknowledge that they may not be the appropriate solution for everyone’s needs and that they may not be appropriate for every particular situation and/or may not be a complete substitute for a face-to-face examination and/or care in every particular situation.
DO NOT USE THIS SERVICE FOR EMERGENCY MEDICAL NEEDS. IF YOU EXPERIENCE A MEDICAL EMERGENCY, CALL 911 IMMEDIATELY.
IF YOU ARE THINKING ABOUT SUICIDE OR IF YOU ARE CONSIDERING TAKING ACTIONS THAT MAY CAUSE HARM TO YOU OR TO OTHERS OR IF YOU FEEL THAT YOU OR ANY OTHER PERSON MAY BE IN ANY DANGER OR IF YOU HAVE ANY MEDICAL EMERGENCY, YOU MUST IMMEDIATELY CALL THE EMERGENCY SERVICE NUMBER FOR YOUR LOCATION AND NOTIFY THE RELEVANT AUTHORITIES.
THE PLATFORM IS NOT INTENDED FOR THE PROVISION OF A CLINICAL DIAGNOSIS REQUIRING AN IN-PERSON EVALUATION AND YOU SHOULD NOT USE IT IF YOU NEED ANY OFFICIAL DOCUMENTATION OR APPROVALS FOR PURPOSES SUCH AS, BUT NOT LIMITED TO, COURT-ORDERED COUNSELING OR EMOTIONAL SERVICE DOG CERTIFICATION. IT IS ALSO NOT INTENDED FOR ANY INFORMATION REGARDING WHICH DRUGS OR MEDICAL TREATMENT MAY BE APPROPRIATE FOR YOU, AND YOU SHOULD DISREGARD ANY SUCH ADVICE IF DELIVERED THROUGH THE PLATFORM.
DO NOT DISREGARD, AVOID, OR DELAY IN OBTAINING IN-PERSON CARE FROM YOUR DOCTOR OR OTHER QUALIFIED PROFESSIONAL BECAUSE OF INFORMATION OR ADVICE YOU RECEIVED THROUGH THE PLATFORM.
Protecting and safeguarding any information that you provide through the Platform is extremely important to us. Our Notice of Privacy Practices can be found above within our New Patient Agreement.
BY USING THE PLATFORM YOU ACKNOWLEDGE THAT YOU HAVE RECEIVED AND AGREE TO THE NOTICE OF PRIVACY PRACTICES. THE NOTICE OF PRIVACY PRACTICES IS INCORPORATED INTO AND MADE A PART OF THIS AGREEMENT. THE SAME HIPAA RULES THAT APPLY REGARDING THE CHANGES AND REVISIONS OF THE NOTICE OF PRIVACY PRACTICES ALSO APPLY TO THE CHANGES AND REVISIONS OF THIS AGREEMENT.
All relevant information and materials provided by you with respect to your treatment shared between you and your Therapist while providing the Behavioral Health Services will be held confidential unless you request in writing to have all or portions of such treatment released to a specifically named person/persons. Limitations of the aforementioned privilege of confidentiality are itemized below:
Occasionally, Therapists may need to consult with other professionals in their areas of expertise in order to provide the best treatment for you. Information about you may be shared in this context.
TO THE EXTENT PERMITTED BY APPLICABLE LAWS, YOU HEREBY RELEASE US AND AGREE TO HOLD US HARMLESS FROM ANY AND ALL CAUSES OF ACTION AND CLAIMS OF ANY NATURE RESULTING FROM THE BEHAVIORAL HEALTH SERVICES OR YOUR ACCESS OR USE OF THE PLATFORM, YOUR USE OR SOMEONE ELSE’S USE OF AND/OR ACCESS TO YOUR ACCOUNT, ANY VIOLATIONS BY YOU OF THIS AGREEMENT, YOUR VIOLATION OF ANY THIRD PARTY RIGHTS INCLUDING (WITHOUT LIMITATION) ANY INTELLECTUAL PROPERTY RIGHTS, PUBLICITY, CONFIDENTIALITY, OR PRIVACY RIGHTS, AND/OR INCLUDING (WITHOUT LIMITATION) ANY ACT, OMISSION, OPINION, RESPONSE, ADVICE, SUGGESTION, INFORMATION AND/OR SERVICE OF ANY THERAPIST AND/OR ANY OTHER CONTENT OR INFORMATION ACCESSIBLE THROUGH THE PLATFORM.
TO THE EXTENT PERMITTED BY APPLICABLE LAWS, YOU UNDERSTAND, AGREE AND ACKNOWLEDGE THAT WE SHALL NOT BE LIABLE TO YOU OR TO ANY THIRD PARTY FOR ANY INDIRECT, INCIDENTAL, CONSEQUENTIAL, SPECIAL, PUNITIVE OR EXEMPLARY DAMAGES.
TO THE EXTENT PERMITTED BY APPLICABLE LAWS, YOU UNDERSTAND, AGREE AND ACKNOWLEDGE THAT OUR AGGREGATE LIABILITY FOR DAMAGES ARISING WITH RESPECT TO THIS AGREEMENT AND ANY AND ALL USE OF THE PLATFORM WILL NOT EXCEED THE TOTAL AMOUNT OF MONEY PAID ON YOUR BEHALF IN THE 3 MONTHS PERIOD PRIOR TO THE DATE OF THE CLAIM.
If the applicable law does not allow the limitation of liability as set forth above, the limitation will be deemed modified solely to the extent necessary to comply with applicable law.
This section (limitation of liability) shall survive the termination or expiration of this Agreement.
YOU UNDERSTAND, AGREE AND ACKNOWLEDGE THAT THE PLATFORM IS PROVIDED "AS IS" WITHOUT ANY EXPRESSED OR IMPLIED WARRANTIES OF ANY KIND, INCLUDING BUT NOT LIMITED TO MERCHANTABILITY, NON-INFRINGEMENT, SECURITY, FITNESS FOR A PARTICULAR PURPOSE OR ACCURACY. THE USE OF THE PLATFORM IS AT YOUR OWN RISK. TO THE FULLEST EXTENT OF THE LAW, WE EXPRESSLY DISCLAIM ALL WARRANTIES OF ANY KIND, WHETHER EXPRESSED OR IMPLIED.
You hereby confirm that you are at least 18 years old of age.
You hereby confirm that you are legally able to enter into this Agreement.
You hereby confirm and agree that all the information that you provided in or through the Platform, and the information that you will provide in or through the Platform in the future, is accurate, true, current and complete. Furthermore, you agree that during the term of this Agreement you will make sure to maintain and update this information so it will continue to be accurate, current and complete.
You agree, confirm and acknowledge that you are responsible for maintaining the confidentiality of your password and any other security information related to your account (collectively "Account Access"). We advise you to change your password frequently and to take extra care in safeguarding your password.
You agree to notify SteadyMD and Headspace Health immediately of any unauthorized use of your Account Access or any other concern for breach of your account security.
You agree, confirm and acknowledge that we will not be liable for any loss or damage that incurred as a result of someone else using your account, either with or without your consent and/or knowledge.
You agree, confirm and acknowledge that you are solely and fully liable and responsible for all activities performed using your Account Access. You further acknowledge and agree that we will hold you liable and responsible for any damage or loss incurred as a result of the use of your Account Access by any person whether authorized by you or not, and you agree to indemnify us for any such damage or loss.
You agree and commit not to use the account or Account Access of any other person for any reason.
You agree and confirm that your use of the Platform, including the Behavioral Health Services, are for your own personal use only and that you are not using the Platform or the Behavioral Health Services for or behalf of any other person or organization.
You agree to use a device that is compatible with the Platform that has sufficient bandwidth to receive Behavioral Health Services.
You agree and commit not to interfere with or disrupt, or attempt to interfere with or disrupt, any of our systems, services, servers, networks or infrastructure, or any of the Platform's systems, services, servers, networks, infrastructure, and other third party services, including without limitation obtaining unauthorized access to the aforementioned.
You agree and commit not to make any use of the Platform for the posting, sending or delivering of either of the following: (a) unsolicited email and/or advertisement or promotion of goods and services; (b) malicious software or code; (c) unlawful, harassing, privacy invading, abusive, threatening, vulgar, obscene, racist or potentially harmful content; (d) any content that infringes a third party right including intellectual property rights; (e) any content that may cause damage to a third party; (f) any content which may constitute, cause or encourage a criminal action or violate any applicable law.
You agree and commit not to violate any applicable local, state, national or international law, statute, ordinance, rule, regulation, or ethical code in relation to your use of the Platform and your relationship with the Therapists and us.
If you receive any file, document, or information from us or from a Thearpist, whether through the Platform or not, you agree to check and scan this file for any virus or malicious software prior to opening or using this file, including but not limited to your electronic health record.
You understand, agree and acknowledge that we may modify, suspend, disrupt or discontinue the Platform, any part of the Platform or the use of the Platform, whether to all clients or to you specifically, at any time with or without notice to you. You agree and acknowledge that we will not be liable for any of the aforementioned actions or for any losses or damages that are caused by any of the aforementioned actions.
The Platform depends on various factors such as software, hardware and tools, either our own or those owned and/or operated by our contractors and suppliers. While we make commercially reasonable efforts to ensure the Platform’s reliability and accessibility, you understand and agree that no platform can be 100% reliable and accessible and so we cannot guarantee that access to the Platform will be uninterrupted or that it will be accessible, consistent, timely or error-free at all times.
This Agreement and our relationship with you shall be governed and construed in accordance with the laws of the State of Missouri, This Agreement shall be construed without regard to any presumptions or rules requiring construction against the party causing the instrument to be drafted.
This Agreement contains the entire agreement between the parties regarding the subject matter of this Agreement, and supersedes all prior oral and written understandings and agreements regarding the subject matter of this Agreement.
We may change this Agreement by posting modifications on the Platform. Unless otherwise specified by us, all modifications shall be effective upon posting. Therefore, you are encouraged to check the terms of this Agreement frequently. The last update to this Agreement is posted at the bottom of this Agreement. By using the Platform after the changes become effective, you agree to be bound by such changes to the Agreement. If you do not agree to the changes, you must terminate your access to the Platform and participation in the Behavioral Health Services.
We may freely transfer or assign this Agreement and/or any of its obligations hereunder.
The headings in this Agreement are used for convenience only and shall not limit, broaden, or qualify the text, and shall not be applied in the interpretation of this Agreement.
If any provision of this Agreement is held by a court of competent jurisdiction to be illegal, invalid, unenforceable, or otherwise contrary to law, the remaining provisions of this Agreement will remain in full force and effect.
Last Updated: May 12, 2021