Informed Consent and Patient Rights

Please correct the errors described below.

1. Whether you are in relationship counseling/coaching or psychotherapy, all information will be kept strictly confidential. There are exceptions where I, as a licensed professional must disclose information. These situations are as follows:

  • *If I find out or have reasonable suspicion that you are abusing a child, an elderly adult who is relatively helpless, I am mandated to report.
  • *If you threaten suicide or I have reasonable suspicion that you might be a serious suicide threat, I have the right to contact others who might help you.
  • *If a court order requires me to release your records.

2. You have a right to know about the procedures being used and you and I both, have a right to terminate our agreement if either one of us feels it is not good for one or both.

3. You should know that successful results are not guaranteed; a lot of the outcome depends on how open, honest and willing you are.

4. Payment is established at the beginning and is due at the time of your session. If your insurance does not pay, you are still responsible.

5. Communications via email or text are not secure and cannot be guaranteed to protect your privacy. In so much, the primary communication should be administrative, e.g., scheduling an appointment.

Cell phones, are not secure. If you do a phone session, I will be on a landline but if you choose to use a Cell phone, your confidentiality cannot be guaranteed.

6. I will not do a phone session with you while you are driving. You commit to pull over and park if you happen to be driving and I have a right to assume you are doing so. If I should suspect that you are driving, I have the right to end the call immediately.

7. If you should bring someone in as a part of your counseling, coaching or psychotherapy, they are considered collaterals and are not patients unless a doctor/patient relationship is established. If you have someone in mind now, please advise him or her of this relationship.

8. If we are doing a virtual telemedicine session, signing this means that you have given your consent to telemedicine.

Finally, we request 48 hours notice of cancellation and have a right to charge you if you do not give adequate (24+ hours) notice.

Your information will be encrypted.

Loading...