Form Data Policy

This Form Data Policy explains what happens when you submit a consultation form on the Achieve Center website. It works alongside our Privacy Policy and Terms of Service. By submitting any form on this site, you agree to the terms below.

What We Collect From the Form

When you submit our consultation form, we collect:

• Your name (parent or guardian)
• Your phone number
• Your email address
• Your child's age (general age range)
• Your insurance provider name
• Any optional message or context you choose to share

We do NOT ask for or collect on our form:

• Your child's diagnosis, medical history, or symptoms
• Your insurance member ID, policy number, or financial account information
• Your child's full date of birth or Social Security Number
• Any other Protected Health Information (PHI)

If you choose to share additional details voluntarily in the optional message field, we will handle that information with the same care described in our Privacy Policy.

How We Use Your Form Submission

We use the information you submit to:

• Contact you by phone, text, and email about your inquiry
• Verify your insurance benefits at no cost to you
• Schedule and prepare for your free consultation
• Coordinate next steps if you choose to begin services with us

Communication Consent (TCPA)

By submitting this form and checking the consent box, you give Achieve Center express written consent to contact you by:

• Phone calls (including from automated systems)
• SMS/text messages
• Email

Message and data rates may apply. Message frequency varies based on your inquiry and our follow-up. Consent to receive marketing communications is NOT a condition of receiving services from Achieve Center.

You can opt out at any time:

• Reply STOP to any text message to unsubscribe from SMS
• Click the unsubscribe link in any marketing email
• Call us at (248) 289-8009 to request removal from any list

Opting out of marketing communications will not affect any clinical care you receive.

Who Sees Your Information

When you submit the form, your information is delivered to:

• Achieve Center's intake and clinical team, who will follow up with you
• Our customer relationship management system (GoHighLevel), which securely stores your inquiry
• Service providers we use to operate our website and communicate with you (such as our email service provider and call tracking system)

We do NOT sell, rent, or trade your form submission to any third party. We do not share your information for any marketing purpose outside of Achieve Center.

How Long We Keep Your Information

We keep consultation form submissions for as long as needed to respond to your inquiry and to maintain business records. If you do not become a client, you can request that we delete your information at any time by contacting us at the number or address below.

If you do become a client, your records become part of your clinical file and are retained according to Michigan and federal healthcare record retention requirements.

Your Rights

You have the right to:

• Know what information we have collected about you
• Request a copy of that information
• Request corrections to inaccurate information
• Request deletion of your information (subject to legal record-keeping requirements if you've become a client)
• Withdraw consent for future communications

To exercise any of these rights, contact us using the details at the bottom of this page.

Security

We use reasonable administrative, technical, and physical safeguards to protect your form submission. This includes encrypted transmission of the form, restricted access to the data, and trusted vendors for storage. No method of transmission over the internet is 100% secure, but we take protecting your information seriously.

Children's Information

Our consultation form is for parents and guardians. We collect information about children only through their parents or guardians, and only what is reasonably necessary to evaluate fit for services. We do not knowingly collect information directly from anyone under 13.

Changes to This Policy

We may update this Form Data Policy from time to time. The "Last updated" date at the top of the page will reflect the most recent change. Continued use of the form after updates means you accept the revised policy.

Contact Us

If you have questions about how your form information is handled, or to make a request related to your data:

Achieve Center
15600 W 10 Mile Rd #13, Southfield, MI 48075
Phone: (248) 289-8009