Informed Consent and HIPAA Notice of Privacy Practices

(v. 3.6)

LSATaccommodations.com | American Disabilities Testing Association LLC

Last Updated: June 24, 2026

Acceptance of This Notice

By accessing or using LSATaccommodations.com, and by checking the acknowledgement checkbox during checkout or account creation, you acknowledge that you have read, understood, and agree to this Informed Consent and HIPAA Notice of Privacy Practices.

Your continued use of the Website after any updates constitutes your reaffirmation of agreement. This Notice works together with our Terms of Use and Privacy Policy (available at https://www.lsataccommodations.com/terms-of-use and https://www.lsataccommodations.com/privacy-policy).

If you do not agree to this Notice, you should not use the platform or proceed with services.

PART 1: INFORMED CONSENT FOR LSAT ACCOMMODATION CONSULTATION SERVICES

Introduction and Nature of Services

Welcome to LSATaccommodations.com, operated by American Disabilities Testing Association LLC ("Company," "we," "us," or "our"). We operate a secure online platform that connects individuals seeking LSAT and other standardized testing accommodations with independent licensed mental health clinicians for the purpose of obtaining professional documentation and letters in support of accommodation requests submitted to testing organizations such as LSAC.

This is a matching and facilitation service only. The Company does not itself provide psychotherapy, counseling, or clinical treatment. The clinical assessment and any resulting documentation letter are provided solely by the independent licensed clinician with whom you are matched.

By using this platform and agreeing to this Notice, you are consenting to: (1) the terms of the platform, and (2) receiving services from the specific clinician to whom you are matched.

Consent to the Platform (American Disabilities Testing Association LLC)

By using this platform and agreeing to this Notice, you consent to the Company:

• Collecting, processing, and storing your personal and health-related information for the purpose of matching you with appropriate clinicians.
• Facilitating the connection between you and independent licensed clinicians.
• Processing payments and managing billing.
• Delivering documents and communications electronically.
• Using de-identified data for platform improvement and analytics (where permitted).

You understand that the Company acts as a facilitator and is not responsible for the clinical judgments, advice, or documentation provided by the independent clinicians.

Telehealth Services

Services on this platform are delivered primarily through secure telehealth (video or phone).

Benefits of Telehealth

Telehealth provides easier and more convenient access to care, allows you to receive services from your home or preferred location, and offers greater scheduling flexibility without the need for in-person appointments.

Risks and Limitations of Telehealth

You understand and accept the following risks and limitations:

• The quality, accuracy, or effectiveness of services may be limited compared to an in-person evaluation.
• Technology issues (such as internet instability, software problems, or device failure) may interrupt or prevent the session.
• The clinician may have limited ability to observe physical cues or conduct certain assessments that would be possible in person.
• There are potential privacy and security risks with electronic communications, even when using secure platforms.
• Telehealth may not be appropriate for all situations or conditions.

You acknowledge that telehealth technology may contain bugs, errors, or limitations that could affect the quality or availability of the session.

Technical Requirements

You are responsible for having a stable internet connection, a compatible device with camera and microphone (for video sessions), and a private location for your consultation.

Emergencies

This platform is not intended for medical or psychiatric emergencies. If you are experiencing a medical emergency, mental health crisis, or thoughts of harming yourself or others, immediately call 911 or go to the nearest emergency room. You may also contact the 988 Suicide & Crisis Lifeline.

If a technical failure prevents communication during a session, please contact us at info@LSATaccommodations.com.

Right to Withdraw from Telehealth

You have the right to withdraw your consent to telehealth at any time without penalty. You may request alternative care arrangements if available or discontinue the process.

Consent to Receive Documentation Electronically

By checking the acknowledgment box or continuing to use the platform, you consent to receive your LSAT accommodation documentation letter and any related communications electronically via email and/or through the secure LSATaccommodations.com portal.

You understand that while the portal uses secure methods, standard email transmission is not 100% secure. You accept this risk and agree to keep your email address and contact information current and accurate.

Consent to the Matched Clinician

You further consent to receive clinical assessment services from the specific licensed clinician to whom you are matched through this platform. This includes the clinician conducting an evaluation (via telehealth or other approved means) for the purpose of determining whether documentation supporting LSAT or other testing accommodations is appropriate.

You acknowledge that the clinician is an independent provider and not an employee or agent of the Company. The clinician is solely responsible for the professional services they render.

Nature of the Consultation Process

The consultation is for the limited purpose of assessing eligibility for and obtaining documentation in support of testing accommodations. It is not psychotherapy or ongoing mental health treatment.

You understand that discussing your disability, symptoms, history, and functional limitations is necessary for the clinician to make an informed professional determination.

Outcomes are not guaranteed. The clinician will exercise independent professional judgment. If the clinician determines that documentation is not clinically supported, you will be informed, and you may be eligible for a refund according to our policies.

Client Rights

You have the right to:

1. Receive appropriate professional services from the matched clinician.
2. Refuse any service or withdraw consent at any time.
3. Receive services without discrimination.
4. Be treated with respect and dignity.
5. Have your information treated confidentially, with the legal exceptions noted below.
6. Be fully informed about fees and payment methods.

Note: Minors 12 and older in California may have specific rights regarding consent under state law.

Confidentiality and Its Limits

Confidentiality between you and the clinician, and between you and the platform, is maintained except in the following circumstances:

1. Reasonable suspicion of child abuse or neglect (report to CPS/law enforcement).
2. Reasonable suspicion of abuse/neglect of a vulnerable adult (report to APS/law enforcement).
3. Clear and imminent threat of serious harm to self or others (duty to warn/protect).
4. Court order or legal requirement to release information.
5. When you authorize release in writing.
6. Consultation with supervisors or other professionals for quality care (limited information).
7. Emergency medical situations requiring hospitalization.

The platform and clinician will make reasonable efforts to protect your privacy.

Records, Data Retention, and Privacy

The platform maintains records necessary to facilitate services, including intake information and communications. The matched clinician maintains their own clinical records. You have the right to request access to your records (subject to legal limitations). Records are retained in accordance with applicable laws and then securely destroyed.

Risks and Limitations

Discussing your disability, history, and symptoms may cause temporary discomfort. The clinician will use professional judgment. Documentation is not guaranteed. The letter is one piece of evidence for LSAC or other testing organizations; final decisions rest with them. This service is not a substitute for ongoing mental health treatment if needed.

Associate and Supervised Clinicians

Some clinicians on the platform may be associates, interns, or supervised providers working under the supervision of a licensed mental health professional. You will be informed if your matched clinician is under supervision. You have the right to ask about the clinician’s qualifications and supervision arrangements.

Termination and Withdrawal

You may withdraw your consent or discontinue the process at any time. Please notify us or your matched clinician. We ask for reasonable notice when possible so appropriate closure or referrals can be arranged.

PART 2: HIPAA NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Our Pledge Regarding Your Health Information

We understand that health information about you is personal. We are committed to protecting it. We create records of the services we facilitate and the information you provide. We need this information to match you with appropriate clinicians, process your requests, deliver documents, and comply with legal requirements.

This Notice applies to all records of your care and information handled through LSATaccommodations.com. It describes how we may use and disclose your protected health information (PHI), your rights regarding that information, and our legal duties.

We are required by law to: (1) Keep your PHI private; (2) Give you this Notice of our legal duties and privacy practices; (3) Follow the terms of this Notice that is currently in effect; and (4) Notify you if we make material changes to this Notice.

How We May Use and Disclose Your Health Information

We may use and disclose your PHI without your written authorization to carry out treatment, payment, and health care operations (such as matching you with clinicians, processing payments, delivering documents, quality improvement, and customer service). We may also disclose PHI to the matched clinician for their treatment activities.

We may use and disclose your PHI to remind you of appointments or to provide information about other services or benefits we offer.

We may disclose PHI in response to a court or administrative order, subpoena, or other lawful process, after making reasonable efforts to notify you or obtain a protective order.

We may disclose PHI without authorization when required or permitted by law, including for public health activities, health oversight, law enforcement, coroners, specialized government functions, workers’ compensation, and to avert serious threats to health or safety.

Uses and Disclosures That Require Your Authorization

Most uses and disclosures of psychotherapy notes (if created), marketing purposes, and the sale of PHI require your written authorization. We will not sell your PHI or use it for marketing without your authorization.

Your Rights Regarding Your Health Information

You have the right to:

• Request restrictions on uses and disclosures of your PHI.
• Request restrictions for out-of-pocket payments.
• Choose how we communicate with you.
• Inspect and copy your PHI (with limited exceptions).
• Receive an accounting of disclosures.
• Amend your PHI.
• Receive a paper or electronic copy of this Notice.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us at info@LSATaccommodations.com or with the Secretary of the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

Changes to This Notice

We may change the terms of this Notice. The new Notice will be posted on our website and available upon request.

Effective Date of this Notice: June 24, 2026

Acknowledgment

BY CONTINUING TO USE THIS WEBSITE AND CHECKING THE HIPAA ACKNOWLEDGMENT CHECKBOX AT CHECKOUT OR DURING ACCOUNT CREATION, YOU ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD, AND AGREE TO THIS INFORMED CONSENT AND HIPAA NOTICE OF PRIVACY PRACTICES, including all telehealth terms and limitations described above.

You consent to the platform processing your information and matching you with a clinician, and you consent to receiving clinical assessment and documentation services from the matched independent licensed clinician via telehealth.