Records & Complaints

In accordance with House Bill 4224 (89th Regular Session) and Texas Health & Safety Code §181.105, Eleva Counseling, PLLC provides the following information to assist consumers in:

  • Requesting health care records
  • Contacting the licensing authority
  • Filing a consumer complaint

How to Request Your Health Care Records

You may request a copy of your medical records during normal business hours. To receive a copy of your medical records, you must contact Practice Manager, Ely Pagayon by telephone at 713-570-6502 or by email at [email protected]. You will be given a medical record request form to complete. 

  • Be very specific about the information you need to have released. Indicate dates of service, types of visits and what parts of the record you need.
  • Sign and date the authorization using your full legal signature. We only allow handwritten signatures, electronic signatures are not allowed.
  • Please be sure to include your telephone number so we can contact you, if we have questions regarding your request.
  • The request may take up to 15 days to process.

How to File a Complaint with the Texas Behavioral Health Executive Council

If you believe your PHI has been or may have been used or disclosed in violation of HIPAA or the Texas Medical Records Privacy Act you may file a complaint with Texas Behavioral Health Executive Council or the Texas Attorney General’s Consumer Protection Division.

Texas Behavioral Health Executive Council 

The Texas Behavioral Health Executive Council consists of the Texas State Board of Examiners of Marriage and Family Therapists, Texas State Board of Examiners of Professional Counselors, Texas State Board of Examiners of Psychologists, and the Texas State Board of Social Worker Examiners. 

Complaints must be in writing and on the Board’s approved complaint form. The complaint may be submitted by mail or email. Obtain the form by downloading and printing from the website or by requesting by phone or in writing.

1801 Congress Ave., Ste. 7.300

Austin, Texas 78701 

How to File a Consumer Complaint with Texas Attorney General

Complaints must be in writing and on the Attorney General’s approved complaint form. The complaint must be submitted online. Obtain the form by accessing the online complaint portal.

P.O. Box 12548

Austin, TX 78711-2548

Questions about House Bill 4224

For questions related to HB 4224, Texas Health and Human Services provides the following contact email: [email protected]