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TERMS, CONDITIONS & CONSENTS

The following terms, conditions, and consents (these “Terms”) govern psychological assessments and related services provided by Time to Evaluate LLC (“Provider”). Please read carefully. By proceeding, you acknowledge and agree to these Terms, which address professional services, payment, administrative support, confidentiality, telehealth, legal rights and other matters.

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Professional Services

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All clinical, diagnostic, and professional services are provided exclusively by Provider, a duly organized and licensed professional practice that engages licensed clinicians who exercise independent professional judgment in accordance with applicable federal and state law. No non‑licensed or non‑professional entity provides, controls, or influences clinical services.

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​Nature of Assessment

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An autism assessment involves several procedures designed to help the licensed psychologist form a diagnostic opinion. The methods used to determine whether a person meets the criteria for autism are consistent with current international standards of practice and evidence-based methods. At present, this typically includes:

  •  Parent/caregiver interview (Autism Diagnostic Interview-Revised);

  • Review of medical, educational, and/or other records made available.

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If further information is required, the assessment may also include:

  • Interviews with other persons identified by you;

  • Questionnaires;

  • Direct testing or clinical observation.

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In addition to the methods described, above, Provider may use clinician-supervised computer-based or artificial intelligence (AI) tools to help organize, evaluate or score information. These tools are used only under Provider’s supervision and do not replace Provider’s professional judgment. Provider, as the licensed psychologist, will conduct the direct testing and will make the final diagnostic evaluation and recommendations. Benefits of assessment include increased clarity regarding diagnosis and treatment planning. Risks include:

  • Not receiving the diagnosis or outcome you expect;

  • Receiving an unexpected diagnosis;

  • Emotional discomfort in discussing personal or family matters.

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No Guaranteed Outcome

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Services are provided for evaluation purposes only. No diagnosis, result, opinion, or outcome is promised or guaranteed. Payment is for the performance of professional services, not for any particular result.

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Administrative Services and Professional Independence

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Certain administrative, technological, and non‑clinical support services may be provided by a separate administrative services organization, Agentic Studios, Inc. (“Administrative Services Organization”). Such services may include scheduling, intake management, technology infrastructure, and payment facilitation. The Administrative Services Organization is not a healthcare provider, does not practice medicine, psychology or any other licensed profession, and does not exercise clinical judgment. The Administrative Services Organization does not direct, control, influence, participate in, or interfere with Provider’s professional judgment, diagnosis, evaluation, treatment, professional decision-making, or the clinician‑patient relationship.

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Payment Terms; Fee Characterization

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Fees are charged for professional services rendered by Provider. Professional fees are earned exclusively by Provider for licensed services performed. Any administrative or processing fees retained by an Administrative Services Organization constitute separately agreed compensation for non‑clinical services only and do not represent fee‑splitting, referral fees, or participation in professional fees. Payment may be required in advance or at the time services are rendered. Payment may be facilitated through third‑party payment processors acting solely in an administrative capacity.

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HSA/FSA; Insurance; Reimbursement

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Certain payment methods, including Health Savings Account (HSA) or Flexible Spending Account (FSA) cards, may be accepted for administrative convenience. Acceptance of a payment method does not determine or guarantee eligibility for reimbursement. Provider makes no representations regarding insurance coverage, medical necessity determinations, or reimbursement under any federal or private benefit program. You are solely responsible for confirming eligibility and coverage.

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Federal and State Regulatory Neutrality

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Nothing in these Terms is intended to induce referrals, influence clinical decision‑making, or violate any federal or state law, including but not limited to corporate practice of medicine doctrines, fee‑splitting prohibitions, the federal Anti‑Kickback Statute, or similar state laws. No payment is conditioned on the volume or value of referrals or the outcome of any evaluation.

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Confidentiality and Legal Limits

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Your confidentiality is very important to us. To the extent applicable, Provider complies with the Health Insurance Portability and Accountability Act (“HIPAA”) and New Mexico state laws regarding patient confidentiality. Limits to confidentiality include:

  • If there is an identifiable risk of harm to yourself or others, Provider must notify persons or authorities able to help ensure safety;

  • Under New Mexico law (Children’s Code §32A-4-3 NMSA 1978), all citizens must report suspected child abuse or neglect;

  • Provider must report suspected abuse, neglect, or exploitation of vulnerable adults;

  • Records may be disclosed if ordered by a court or otherwise required by law;

  • Limited information (name, services provided, amount due) may be disclosed for collections purposes. Electronic communications (email, text) are not always fully secure and should be used only for scheduling or administrative matters.

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Sharing Results with Referring Partners

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If you were referred for evaluation by a partner clinic, you consent to Provider sharing the results of your evaluation, including standardized test results (such as Vineland-3 scores and other assessment data), with the referring partner clinic. This sharing is necessary for the partner clinic to complete their assessment procedures and provide appropriate follow-up care. All shared information will be handled in accordance with applicable privacy laws and professional standards.

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Payment and Cancellation Policies

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The fee for an autism assessment is $750, regardless of diagnosis outcome. No refunds will be issued once the assessment has commenced. Payment is due at the time of service and may be made by cash, check, credit card, or debit card. Credit/Debit card or ACH transactions may include a processing fee. Provider is not a member of any managed care plans and is considered out-of-network for all insurance companies. Provider does not accept insurance as direct payment; however, you may submit a receipt to your insurer, which may or may not reimburse you. You are solely responsible for knowing and following the requirements of your insurance plan. You are responsible for the full fee regardless of insurance reimbursement. If you have an outstanding balance and fail to pay, Provider may use legal means to secure payment, including collections or small claims court. Associated legal fees and costs will be added to the claim. Your appointments are reserved specifically for you. To cancel or reschedule, at least 24 hours’ notice is required by telephone at (505) 225-1664. Email is not sufficient. Cancellations with less than 24 hours’ notice will incur a $200 fee, which insurance does not cover. Exceptions for true emergencies may be granted at Provider’s sole and absolute discretion. The base fee does not include:

  • Attendance at meetings with schools or other professionals;

  • Additional services requested;

  • Psychological treatment;

  • Participation in legal proceedings. A parent or caregiver is required for ADI-R administration during scheduled appointment time.

 

Telehealth Consent

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Telehealth services are provided only where legally permitted and clinically appropriate. Prior to starting, you agree to the following:

  • Potential benefits and risks of telehealth differ from in-person sessions (e.g., limits to confidentiality);

  • Applicable HIPAA and confidentiality rules still apply; no sessions may be recorded without consent;

  • Provider will explain use of the secure platform selected for sessions;

  • You must use a webcam or smartphone and a secure, private environment;

  • Public/free Wi-Fi should not be used;

  • You must be on time and notify Provider in advance if you must cancel;

  • A backup plan (e.g., alternate phone number) will be used if technical issues occur;

  • An emergency plan must be in place with a designated emergency contact and nearest ER;

  • Insurance reimbursement for telehealth varies and is your responsibility to verify;

  • Provider may determine telehealth is not appropriate and require in-person sessions.

 

Limitations of Services

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Provider does not guarantee any particular diagnosis, outcome, or treatment result. Services are provided for clinical purposes only and not for legal or forensic purposes unless separately contracted in writing.

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Termination of Services

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Provider reserves the right to terminate services consistent with applicable law, including without limitation if you fail to comply with treatment recommendations, are abusive or disruptive, or fail to pay fees when due.

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Indemnification

 

You agree to indemnify and hold harmless Administrative Services Organization, as well as Provider, its clinicians, and staff from any claims, damages, or expenses arising from your misuse of assessment results or disclosures made at your request.

 

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