INFORMED CONSENT

SOME THINGS YOU SHOULD KNOW ABOUT COUNSELING

Psychotherapy or counseling is a safe and effective way to address a variety of personal, emotional, and relationship problems. It is completely voluntary on your part, and you are expected to be an integral part in planning and carrying out your treatment plan. The therapy process can be enlightening and rewarding but it also can be awkward and stressful, and may encourage you to step out of your comfort zone. If at any time you feel confused or uncertain about the therapy process, do not hesitate to talk with me about your concerns. There is no minimum number of sessions required, and you may stop therapy at any time without penalty. Either of us may terminate our therapy relationship if it no longer is necessary, appropriate or healthy. 

You have the right to confidentiality. I may not discuss your particular case without your written permission, except in certain circumstances. These include, but are not limited, to the following: 

I am required by law to report child abuse, or the abuse of an elderly or disabled person.  I may consult your treating physician without prior notice in the event of an emergency.  If you are suicidal, I will contact your emergency contact person, your treating physician or emergency response personnel.  If you are threatening to harm someone else and I believe it is a credible threat, I am required to contact law enforcement.  If I, or my records, are subpoenaed I am required by law to comply.  If you are using your medical insurance to pay for sessions, I am required to give your name, ID number, (which may be your social security number) a diagnosis, the date(s) of service, and what type of service was provided. I cannot be responsible for the confidentiality of information once I have sent it to the insurance company.   In the event of my death or disability, your signature authorizes my office to designate an appropriate custodian to assume responsibility for your records. ="margin-bottom:>

You have the right to review your client records. In the event that you wish to review your records, please make a written request to me at the address below. I must comply within 30 days or give reason for my denial. I am allowed to charge reasonable fees for the records request. 

A word about children: If I am treating your child and there are custody orders on file in a court of law, I will need a copy of those orders. In general, I prefer that both parents are active and engaged in the therapy process. However, I understand that this is not always possible or in the child's best interest. Please talk with me honestly and openly about your concerns so that I will be aware of the situation. 

Limitations of services: I cannot prescribe medication, I do not have hospital admitting privileges, nor do I have any specialized treatment program. Many people need a higher level of care than I can provide, and I will be happy to work with you to find the appropriate level of care, while still providing you with therapy.  If I believe that your issues are beyond the scope of my expertise, I may refer you for consultation to someone with specific training.

Please give 24 hour notice if you need to change or cancel your appointment. I am very understanding about emergencies, however, if you miss an appointment without adequate notice, I may charge you for the missed appointment. If you miss an appointment, it is your responsibility to reschedule that appointment. If you do not contact me within seven days of a missed appointment, I will assume that you wish to discontinue counseling. 

Phone contact: I check voicemail daily and will return messages within 24 hours on weekdays, and on the next workday, if the   message is left on a weekend or holiday. If I have not returned your phone call within the expected time, please try again, as the message may have been lost. If you are experiencing a mental health or other emergency, call 911 or go to an emergency room and ask them to contact me.

Text and email: I typically use text and email messages for administrative or logistical issues. If you communicate with me by text or email, you acknowledge and agree that you may be compromising confidentiality by using such means of communication.