Patient Notices

Effective date: These notices take effect on October 13, 2026.

1. Notice of Privacy Practices

Our Notice of Privacy Practices explains your privacy rights and how we use, share and protect your health information.

Read our full Notice of Privacy Practices

Your privacy rights, in short. You can:

• See and get a copy of your health and billing records. The Notice explains the few exceptions.
• Ask us to correct your records.
• Ask us to contact you in a certain way or at a certain place, such as only by email or only at one phone number. You don't have to tell us why.
• Ask us to limit what we use or share. We don't have to agree, except in some cases when you pay for a service in full yourself.
• Get a list of certain times we shared your information.
• Get a paper copy of the Notice at any time. Ask at the front desk, call 616-287-3218 or email admin@findyourpersonalcourage.com. The Notice is also posted in our office.

Questions or a privacy complaint? Contact our Privacy Officer, the Director of Operations and Client Services, at 616-287-3218. You can also complain to the U.S. Department of Health and Human Services, Office for Civil Rights (see Section 6). We will not retaliate against you for making a complaint.

2. Nondiscrimination Notice

Personal Courage, LLC follows federal civil rights laws. We do not discriminate against anyone, exclude anyone or treat anyone differently because of race, color, national origin (including limited English proficiency and primary language), age, disability or sex (including sex characteristics, intersex traits, pregnancy or related conditions, sexual orientation and sex stereotypes).

We also follow Michigan law. So we also do not discriminate because of religion, sexual orientation, gender identity or expression, marital status or any other characteristic protected by law.

Personal Courage provides, free of charge and in a timely way:

• Aids and services so people with disabilities can communicate with us effectively, such as qualified sign language interpreters and written information in other formats (large print, braille, accessible electronic formats and others)
• Language help for people whose primary language is not English, such as qualified interpreters and information written in other languages
• Reasonable changes to our policies and practices when a person with a disability needs them, such as welcoming a service animal

This help is also for parents, guardians and companions who need it to communicate with us.

To ask for this help, call 616-287-3218 (relay users dial 711), email admin@findyourpersonalcourage.com or ask at the front desk. Please tell us before your appointment when you can.

If you believe we failed to provide this help, or discriminated in another way, you can:

• Tell us. Contact our civil rights contact, the Director of Operations and Client Services, in person, by phone (616-287-3218), by fax (616-239-2820), by email (admin@findyourpersonalcourage.com) or by mail (Personal Courage, LLC, 2040 Raybrook St. SE, Suite 300, Grand Rapids, MI 49546). We will help you make your complaint if you need it.
• Complain to the U.S. Department of Health and Human Services, Office for Civil Rights, generally within 180 days of the discrimination: online at ocrportal.hhs.gov; by phone at 1-800-368-1019 (TDD 1-800-537-7697); by email at OCRComplaint@hhs.gov; or by mail at U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington, D.C. 20201.
• Complain to the Michigan Department of Civil Rights, generally within 180 days: 1-800-482-3604 (Michigan Relay 711; video phone 313-437-7035); www.michigan.gov/mdcr; 3054 West Grand Boulevard, Suite 3-600, Detroit, MI 48202.
• Complain to the City of Grand Rapids Office of Diversity and Inclusion, within 180 calendar days: 616-456-3027; hro@grcity.us.

This notice is at www.personal-courage.com/patient-notices/, and it is also posted in our office. You can also read there how we handle concerns. It is available in other formats on request.

3. Free Language Help and Disability Aids

Language help and disability aids are free. Personal Courage provides language help and disability aids free of charge when you, as a client, parent, guardian or companion, need them to communicate with us. This includes interpreters for other languages, American Sign Language (ASL) interpreters qualified under Michigan law and written information in other languages or in large print, braille or another format you can use. We arrange interpreters through a professional interpreting service, usually by phone or video. You never have to bring your own interpreter or pay for one.

To ask, call 616-287-3218 (relay users dial 711), email admin@findyourpersonalcourage.com or ask at the front desk. Please tell us before your appointment when you can, so we can have help ready. This notice is available in other formats on request.

4. Good Faith Estimate

Who this is for. You can get a Good Faith Estimate from us if you:

• have no health insurance
• have a private, employer or federal-employee health plan and choose not to use it for your care with us
• have Medicare or Medicaid and want a service it doesn't cover

Ask us if you're not sure.

How to ask. Call 616-287-3218, email admin@findyourpersonalcourage.com or ask at the front desk. If you ask us about the cost of care, we treat your question as a request for a Good Faith Estimate.

This notice is available in other languages and in accessible formats. Just ask.

Insurance and private pay options

5. Your Rights and Responsibilities

Our Statement of Client Rights and Responsibilities explains your rights as a client, what we ask of you, our fees and how cancellations work, the limits of privacy and how privacy works for children and teens. You get a copy before treatment begins.

Read our full Statement of Client Rights and Responsibilities

In a crisis or emergency, call or text 988, call 911 or go to the nearest emergency room. Text, email and voicemail to us are not crisis services.

6. How to Raise a Concern

We want to hear from you about anything, including your care, our team, billing, privacy, access, language help or discrimination.

How to reach us. Use whatever way is easiest: in person or by phone (616-287-3218; relay users dial 711), email, fax or mail, using the details in Section 2. It doesn't have to be in writing, and you can stay anonymous. Please don't put health details in a text or email. We'll reach you another way you've told us is safe.

Who looks into it. Our Clinical Director handles concerns about your clinical care or a clinician's conduct. Our Director of Operations and Client Services, who is our Privacy Officer and civil rights contact, handles every other concern, including privacy, discrimination, billing and Good Faith Estimates. If your concern is about the person who would handle it, or that person is away: our Clinical Director handles concerns about privacy, discrimination, billing or the office, and a fully licensed clinician who is not involved handles concerns about clinical care or a clinician's conduct. If your concern is about our CEO, our Director of Operations and Client Services handles it, and there is no second review inside the practice.

What happens next

• We will generally acknowledge your concern within two (2) business days and respond within fifteen (15) business days. If we need more time, we will tell you when to expect a response and why.
• For a formal complaint, and for any complaint about privacy or discrimination, we'll also give you our answer in writing. A formal complaint is any complaint you ask us to answer in writing.
• If you're not satisfied, you can ask for a second review by our CEO, unless your concern is about the CEO or a decision the CEO made. The CEO's decision is final within the practice.
• We keep your identity private and share it only as needed to look into your concern or as the law requires.
• If you need an interpreter or another aid to raise a concern, we'll provide it free of charge.
• No one will retaliate against you or treat you worse for raising a concern.

If someone's safety is at risk. Tell us right away if your concern involves someone's safety, or possible abuse or neglect. Any report the law requires is made immediately. It doesn't wait for this process. In an emergency, call 911. In a mental health crisis, call or text 988.

Outside options. You can also contact any of these at any time. You don't have to use our process first.

• Privacy: the Office for Civil Rights (contacts in Section 2). A privacy complaint must be in writing, on paper or online, and is generally due within 180 days of when you knew, or should have known, about the problem. The Office can extend this for good cause.
• Discrimination: the agencies in Section 2.
• A licensed clinician's conduct: Michigan Department of Licensing and Regulatory Affairs, Bureau of Professional Licensing, www.michigan.gov/lara/bureau-list/bpl/complaint.
• A Good Faith Estimate or a bill dispute: the No Surprises Help Desk, 1-800-985-3059, www.cms.gov/nosurprises.
• Your health plan: Medicaid health plan members can use their plan's grievance and appeal process or the Michigan Department of Health and Human Services Beneficiary Help Line, 1-800-642-3195. Medicare members can take a concern about the quality of a Medicare-covered service to their Medicare quality improvement organization (call 1-800-MEDICARE to find it). Members of other plans can contact their plan about coverage or billing.

• 616-287-3218 Call
• Fax: 616-239-2820
• admin@findyourpersonalcourage.com
• 2040 Raybrook St. SE, Suite 300, Grand Rapids, MI 49546

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