CONSULTATION INTAKE

COMPASSION CENTER CLINICAL AND PROGRAM REGISTRATION INSTRUCTIONS

Welcome to Compassion Center. We’re glad you’re here.

This is our streamlined registration process, designed for faster service, accurate records, and prompt appointment approval. Please read these instructions and the Notice of Privacy Practices below before you begin. Each step gives us something we need to serve you well.

STEP 1: START REGISTRATION

Begin by completing the Web Registration Form. This form collects no protected health information. It is used to:

1) Collect your name, phone number, and email address, and confirm you are at least 18 years of age. A patient under 18 may be registered only by a parent or legal guardian, where the patient’s state program permits; the guardian completes registration on the patient’s behalf and must be present for the entire appointment.

2) Record how you would like us to contact you. Appointment and care-related emails are part of your care. Text messages are optional; you may choose appointment and care-related texts, other messages, both, or neither, and you may change your choice at any time by replying STOP or contacting us. Message and data rates may apply.

After submitting the Web Registration Form, you will be redirected to Step 2.

STEP 2: MAKE YOUR PAYMENT

You will be redirected to our Secure Payment Portal to pay the $159.99 consultation fee. We accept debit and credit cards only; we do not accept cash, checks, or money orders. Discounts for Veterans, SNAP and Medicaid recipients, IPA and CPR members, coupon holders, and sliding-scale applicants are applied as described under Fees.

Once your payment is confirmed, you will be forwarded to Step 3.

STEP 3: COMPLETE YOUR HEALTH HISTORY FORM

After payment, you will be directed to our online health history form, hosted on Compassion Center’s Google Workspace environment under a Business Associate Agreement and secured for protected health information. This is where you provide:

1) Your current diagnoses

2) Two years of medical history (new patients)

3) A current list of every medication (prescription and over the counter) and supplement you take

4) Any supporting information you want the provider to see

Please disclose every medication (prescription and over the counter) and supplement, no matter how common. Interactions matter, and your provider can only account for what you tell us.

STEP 4: BOOK YOUR APPOINTMENT

After completing the health history form, you will choose your preferred appointment date and time in our online scheduling system. You will receive a confirmation email with your appointment details and your Zoom link. Please open the link as soon as you receive it so your app and any components are updated before the day. On the day, join 15 minutes early in case there are updates or your provider is running ahead.

CARE TEAM AND CONSULT ASSISTANTS

Your consultation is with a licensed provider. A member of Compassion Center’s care team, acting as the provider’s assistant, may be present for part or all of your visit, on camera or off, to help with scheduling, onboarding, your Zoom connection, your state’s medical cannabis program requirements, vendor or dispensary program details, forwarding documentation to you and/or to your providers and similar tasks necessary to deliver your care. Assistants are part of your care team under the Notice of Privacy Practices below, are bound by the same privacy obligations as the provider, and do not make clinical decisions. If you would prefer that no assistant be present for the clinical portion of your visit, tell the provider at the start of the consult and your request will be honored wherever it does not prevent us from delivering care.

ADDITIONAL INFORMATION

• New patients: provide two years of medical history documenting your diagnosis.
• Returning patients: you may be asked for a medical record from within the past year.
• All patients: please have your release forms and medical records complete before your appointment.

VETERANS

If you are a Veteran, a VA-specific Release of Records may be sent to your email through DocuSign. Please complete, sign, and return it, or send your records to us, at least 14 days before your appointment.

NEED TO FOLLOW UP?

Email: scheduling@compassion-center.org · Voice: 1-844-THC-COMPASSION (1-844-842-2667) · Fax: 1-888-503-1312 or +1-541-484-0891

Once we receive and review your medical records, we will confirm your appointment. Records from your provider can take 2–4 weeks to arrive; if you already have them, upload or send them now to expedite the process.

FEES, CANCELLATIONS, REFUNDS, AND CHARGEBACKS

Consultation fee. $159.99 USD, before any Veterans, SNAP, Medicaid, IPA, CPR, coupon, or sliding-scale discount.

Cancellations and refunds — one rule. If you cancel more than 24 hours before your appointment, your consultation fee is refunded in full; email scheduling@compassion-center.org and we will process it. If you cancel with less than 24 hours’ notice, or miss your appointment, a $50 fee applies and the balance of your consultation fee is credited toward a rescheduled appointment. Once a consultation has been delivered, the fee is non-refundable.

Chargebacks. Please bring any concern about a charge to our staff first; most are resolved the same day. A chargeback filed for a consultation that was delivered as scheduled incurs a $75 administrative fee for the time required to contest it. A disputed charge for a service that was not delivered is refunded without any fee.

State programs. Registering with Compassion Center does not register you with your state’s medical cannabis program. State applications and separate state fees typically apply.

Questions about these policies: 1-844-842-2667 ext. 6.

NOTICE OF PRIVACY PRACTICES

Effective October 23, 2026. Revised October 2026. This Notice applies to Compassion Center, its Integrative ECS clinics, and the clinic system operating under them, and to their providers, assistants, staff, students, and volunteers.

This Notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

OUR LEGAL DUTIES

We are required by law to maintain the privacy of your protected health information, to give you this Notice of our legal duties and privacy practices, to follow the Notice currently in effect, and to notify you if a breach of your unsecured protected health information occurs. We reserve the right to change this Notice and to make the new Notice apply to information we already hold; the current version is always available at https://compassion-center.org and in our offices.

HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION WITHOUT YOUR AUTHORIZATION

• Treatment. To provide and coordinate your care within our clinic and with providers we refer you to, for continuity of care.
• Payment. To bill and collect for services, obtain approvals, and process insurance or program claims where applicable.
• Health care operations. Quality review, audits of care and staff performance, training, and the administration of the clinic.
• Appointment reminders and care communications. To remind you of appointments and to tell you about treatment options, care alternatives, and state program requirements relevant to your care.
• Business associates. With contracted parties who perform services for us under written agreements that require them to protect your information.
• Fundraising. We may contact you about our charitable programs. You have the right to opt out of fundraising communications, and we will tell you how with each such communication.
• Persons involved in your care. With a family member, friend, or other person you identify as involved in your care, or as needed in an emergency.
• Authorized representatives. With individuals you have authorized in writing, or as required by law.
• Legal and law enforcement. As required by subpoena, court order, or warrant; for law enforcement purposes as permitted by law; or to avert a serious and imminent threat to health or safety.
• Public health and safety. To report abuse or neglect, communicable disease, adverse events, or as otherwise required for public health activities.
• Health oversight. To agencies authorized by law to oversee the health care system.
• Workers’ compensation. Only where Compassion Center is a party to the claim and as required by law, and not otherwise.
• Research. With our authorized research affiliates, including the Center for Incubation & Findings Research (CIFR) and the Community Based Clinical Cannabis Evaluation & Research Network (CBCCERN), for public health innovation, under review processes that protect your privacy. You may opt out of research disclosures by telling us in writing.
• Incidental disclosures. Incidental to a permitted use or disclosure, and minimized by reasonable safeguards.

USES AND DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION

Most uses and disclosures of psychotherapy notes, uses and disclosures for marketing purposes, any sale of your health information, and any use or disclosure not described in this Notice require your written authorization. You may revoke an authorization at any time in writing; the revocation will not affect uses or disclosures already made in reliance on it.

SPECIALLY PROTECTED HEALTH INFORMATION

Additional federal and state protections may apply to information about HIV/AIDS, mental health, substance use disorder treatment, developmental disabilities, and genetic information, and we follow them.

YOUR RIGHTS

• Access. To inspect and obtain a copy of your records, including an electronic copy where we keep them electronically; standard copy fees apply.
• Amendment. To request a correction to your record; we may deny the request in writing with the reason and your options.
• Accounting of disclosures. To receive a list of certain disclosures we have made.
• Restrictions. To request restrictions on how we use or disclose your information. We are not required to agree, except that we must honor a request not to disclose information to a health plan for a service you paid for in full out of pocket.
• Confidential communications. To ask that we contact you in a specific way or at a specific location, which we will accommodate where reasonable.
• Breach notification. To be notified if your unsecured protected health information is breached.
• Paper copy. To receive a paper copy of this Notice at any time, even if you agreed to receive it electronically.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with the Office of Accountability & Transparency, which serves as Compassion Center’s privacy office: oat@compassion-center.org · OAT hotline 1-888-229-6777 · PO Box 434, Molalla, OR 97038. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services, Office for Civil Rights: 200 Independence Avenue, S.W., Washington, D.C. 20201 · 1-800-368-1019 · www.hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint.

CONTACT

1-844-842-2667 or +1-541-484-6558 · https://compassion-center.org

By proceeding, you confirm that you have read, acknowledge, and accept this Notice of Privacy Practices and the Fees, Cancellation, Refund, and Chargeback policies above. The current versions are available on our website and in our offices.