My T and Pdoc are in a private group practice. The office staff reads the emails, prints them out and gives them to clinicians to sign off on. The printed email goes into the clients file. I've never emailed my T but my pdoc responds to emails with phone calls. There is no charge for emails. I use insurance for both providers and I think this is why they don't email. I know where I work insurance carriers wont pay for time billed for emails. So private practice Ts don't have to worry about this but others probably don't email for this reason.