Olivia's Informed Consent

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PRELIMINARY REQUIREMENTS FOR THERAPY

The payment form and informed consent are required by the end of the first session. In the event these are not completed before your first session, we will complete them together prior to starting the diagnostic assessment (DA). The DA can take anywhere between 1-2 sessions to complete. Unless you are in crisis or recently completed a DA with another provider at Fuller Living, a DA must be completed for insurance purposes.


CONFIDENTIALITY

All information is confidential with a few exceptions. As an individual under close supervision, I may share information with my direct supervisor for assistance with treatment planning. Moreover, if you pose a danger to yourself or others, I am required to break confidentiality. Danger to yourself or others generally involves a clear plan and a strong intent for harm. For minors, safety concerns must be shared with parental figures.


TELEHEALTH

For telehealth (virtual) sessions, a private space where you are free from other people and distractions is required. You understand that technological issues such as losing internet connection may occur during session. It is recommended that food does not be consumed during the session as this may serve as a distraction to the client, however, beverages are okay. It is also recommended that phones be put on “do not disturb” mode during session.


LATE & CANCELLATION POLICY

Therapy sessions will end after about 53 minutes due to me having subsequent sessions. If you have not arrived 5 minutes into session, I will give you a call and leave a voicemail if there is no answer. If your voicemail has not been set up or is full, I will send you a text message. I will be available until 15 minutes into session at which point I will assume you are not available and cancel session.


We have a 24 business hour cancellation policy. We hold times in our schedules just for you. If you need to cancel for any reason with less than 24 business hours there will be a charge of $50 (With the exception of state funded insured clients). In the event there are 2 or more late cancellations or no call/no shows within a month, the counselor reserves the right to transition the client from scheduled-out sessions to same-day scheduling until timely and consistent attendance resumes.


CONTACTS

In the event you need to cancel or reschedule an appointment, please do so through square or contact Olivia Falken at oliviadawson@fullerlivingandassociates.com. You may also reschedule through Becky Rosier through the main number at 763-647-8188 or Beckyrosier@fullerlivingandassociates.com. I can also be reached at 507-400-3466 and I generally respond within 24 hours on weekdays.


You understand that I do not check my business number text (messages or voicemail) on the weekends. If you are in crisis and in need of immediate help, please call 911 or go to the nearest hospital. If you are not in immediate physical danger, please contact any of the following:


National Suicide Prevention Lifeline: Call 800-273-8255, Text 988 (available 24/7) https://988lifeline.org/

National Crisis Text Line: Text “HOME” to 741741 (available 24/7) https://www.crisistextline.org/

Minnesota Warmline: Call 877-404-3190 or Text “Support” to 85511 (available Monday-Saturday, 5pm-10pm). https://namimn.org/peer-support-warmline-available-statewide/


Finally, I am not competent nor qualified to provide visitation or custody evaluations. Please sign below:

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