Accessibility for Therapy Websites: WCAG Basics, ADA and Section 504

A therapy website should be usable by people with disabilities: readable text, working keyboard navigation, labeled forms, captioned video and images with text alternatives. The Justice Department says the ADA's requirements apply to the online services of businesses open to the public, including medical offices. A 2024 HHS rule also sets a WCAG 2.1 AA standard, with 2027 and 2028 deadlines, for practices that receive HHS federal financial assistance.

Accessibility also matches the work you do. People reaching out for therapy may have anxiety, ADHD, low vision, trauma responses or chronic illness. A site that is clear, predictable and easy to use helps all of them. This guide explains the legal context, the WCAG basics and the fixes that matter most.

It is part of our Therapy Practice Marketing Guide. It is not legal advice; ask counsel how the rules apply to your practice.

Why it matters for therapy practices

Three reasons, in order of importance:

1. Clients. If someone using a screen reader cannot complete your contact form, you have lost a client who wanted your help.
2. Ethics. The ACA Code of Ethics, Standard H.5.d, says counselors who maintain websites "provide accessibility to persons with disabilities."
3. Legal risk. Federal law and some state laws apply, as described below.

The ADA

The Department of Justice's guidance on web accessibility and the ADA says businesses open to the public must provide "full and equal enjoyment" of their services to people with disabilities. Its list of examples includes "hospitals and medical offices." The DOJ says it "has consistently taken the position that the ADA's requirements apply to all the goods, services, privileges, or activities offered by public accommodations, including those offered on the web."

The same page says businesses have flexibility in how they comply, because the DOJ has not issued a detailed technical regulation for private businesses' websites. It points to WCAG and the federal Section 508 standards as helpful guidance.

HHS Section 504 rule

If your practice receives federal financial assistance from HHS, a separate rule applies. The regulation at 45 CFR 84.84 says recipients must make their web content and mobile apps conform to WCAG 2.1 Level A and AA:

• Beginning 11 May 2027 for recipients with 15 or more employees.
• Beginning 10 May 2028 for recipients with fewer than 15 employees.

The rule covers content provided "directly or through contractual, licensing, or other arrangements," so third-party booking or intake tools on your site can count. The Section 1557 rule at 45 CFR 92.204 also requires covered health programs to make information and communication technology accessible.

Whether your practice counts as a recipient depends on how you are paid, and that is a question for a healthcare attorney. Many practices aim for WCAG 2.1 AA or 2.2 AA regardless, since it is the clearest available standard.

WCAG in plain words

The Web Content Accessibility Guidelines (WCAG) are published by the W3C. Its WCAG at a glance summary groups the guidelines into four principles:

Levels A and AA are the usual targets. AAA is stricter and rarely required for a whole site.

What changed in WCAG 2.2

According to W3C's What's New in WCAG 2.2, version 2.2 became a W3C Recommendation on 5 October 2023. It adds nine success criteria, including:

• Focus Not Obscured (Minimum), AA: sticky headers or chat bubbles must not hide the element a keyboard user is on.
• Dragging Movements, AA: anything done by dragging needs a simple alternative.
• Target Size (Minimum), AA: buttons and links need enough size or spacing to tap.
• Consistent Help, A: help options, like your phone number, appear in the same place on each page.
• Redundant Entry, A: do not make people retype information they already entered in the same process.
• Accessible Authentication (Minimum), AA: logins should not depend on memory puzzles.

The W3C also notes that 4.1.1 Parsing is obsolete and removed in 2.2.

Fix these first

The DOJ's guidance lists common barriers. Here is how each shows up on therapy sites:

1. Poor color contrast. The DOJ gives the example of "light gray text on a light-colored background." Soft, muted palettes are common on therapy sites. Check contrast before you launch.
2. Color alone conveying meaning, such as red text marking required fields. Add a text label too.
3. Missing alt text. Describe your headshot and office photos. Skip decorative images with empty alt text.
4. No captions on video. If you have an intro video, caption it and offer a transcript.
5. Inaccessible forms. The DOJ calls for labels screen readers can announce, clear instructions and error messages. Contact and intake forms are the most important pages on your site to get right.
6. No keyboard access. Try tabbing through your site. Can you open the menu, reach the booking button and submit the form?

Other therapy-specific checks:

• Booking widgets and client portal links from third parties. Test them; you are responsible for what you embed.
• PDF intake forms. Offer an accessible online version or tagged PDFs.
• Pop-ups that trap focus or cannot be closed with a keyboard.

Calm and accessible

Calm design and accessible design work well together if you follow a few rules:

• Calm colors, strong contrast. Use soft backgrounds with dark text, not pale text.
• No autoplay. Video or audio that starts on its own is jarring and hard to stop for some users.
• Limit motion. Parallax and animated backgrounds can cause discomfort. Respect the "reduce motion" setting.
• Predictable layout. Keep navigation and the contact button in the same place on every page.
• Plain language. Short sentences and clear headings help people who are stressed or have cognitive disabilities.

For more on calm design, see How to Create a Calming, Client-Friendly Website and Mobile-Friendly Website Design for Mental Health Professionals.

A note on overlays

Some products promise one-line accessibility fixes through a toolbar or overlay. The DOJ guidance does not endorse any product, and it points to WCAG as the guide. An overlay does not fix missing form labels or inaccessible booking widgets in your code. Fix the underlying site.

Next step

Accessibility is easiest to build in during a redesign. When you are ready to plan one, read How Much Does a Therapist Website Cost?. If you want an expert review, our WCAG accessibility services cover testing and fixes. To spot the biggest issues now, get a free 20–30 page website audit within 24 hours.

Frequently asked questions