Fuller Living & Associates, Llc Informed Consent, Policy, & Agreements for Consulting Services

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Consulting Services

It is important for you to be aware of important information regarding coaching and consulting services (hereafter collectively referred to as “consulting”), as well as obtain your informed consent for participating in these services.

As therapists and consultants, we can offer a range of services to support individuals in their personal and professional growth. While these services aim to help clients achieve their goals and improve their lives, there are important differences between them.

Counseling, also known as psychotherapy, is a type of mental health treatment that is designed to address psychological or emotional issues. Therapists work with clients to identify and understand the underlying causes of their distress, develop coping skills and strategies, and work towards healing and recovery. Counseling typically involves a deep exploration of a client's past experiences, emotions, and behaviors, and may involve a variety of therapeutic techniques such as cognitive-behavioral counseling (CBT), psychodynamic counseling, or mindfulness-based approaches. Counseling is usually recommended for individuals who are struggling with issues such as anxiety, depression, trauma, addiction, or relationship problems.

Consulting, on the other hand, is focused on helping clients achieve their goals and reach their full potential. Consultants work with clients to identify their strengths and weaknesses, set achievable goals, and develop action plans to overcome obstacles and achieve success. Consulting is future-oriented and action-oriented, and may involve strategies such as accountability, motivation, and skill-building. Consulting may also include services that provide expert advice and guidance to individuals or organizations on a particular topic or issue. Consultants are often experts in a specific field and use their knowledge and experience to help clients identify problems, develop solutions, and implement strategies for success. Consulting is focused on providing clients with specific, targeted advice and support. Most of the consulting we provide relates to career development goals.

Consulting is typically recommended for individuals who are looking to improve their performance in areas such as career, leadership, and communication, as well as receive support for career development.

Consulting does not include mental health services, and it is not a substitute for counseling or other medical or mental health treatment. Consulting clients who need counseling will be referred to therapists either in lieu of consulting or in addition to it. We do not diagnose or treat mental health conditions as part of consulting, nor do we write assessments, treatment plans, or letters. We do not provide consulting if we believe a client is in need of mental health treatment for suicidal ideation, psychosis, or an acute trauma state. If we determine that our services are not appropriate or adequate for you, we may refer you to other professionals or resources that may be better suited to your needs.

In summary, counseling is focused on addressing emotional and psychological issues. Consulting, on the other hand, focuses on goal-setting for the purposes of career development and career skill growth, and may include providing expert advice and guidance in a specific area. While there may be some overlap between these services, it's important to understand the differences so that you can choose the type of service that is best suited to your needs.

You have chosen to proceed with our consulting services. By signing this contract, you are agreeing to pursue a consulting relationship with me, not a therapeutic one.

Virtual Platform-Based Consulting

1. I understand that my consultant can provide virtual platform-based consulting (hereafter referred to as virtual consulting) services when in a situation where I cannot physically be at my consultant’s office.

2. My consultant has explained that virtual consulting technology will be used in sessions that I cannot attend in person. I understand that this means the sessions will differ from in-person meetings because I will not be in the same room as my consultant.

3. I understand there are potential risks to this technology, including interruptions and technical difficulties.

4. I understand that my informed consent for consulting services that I signed in order to initiate services is also applicable to me when using virtual platform-based consulting.

5. I understand that my consultant will use a HIPAA-compliant web platform to provide services (e.g., Doxy) and then another platform if that does not work and that I will receive a link to or instructions for accessing the “online meeting room”.

6. I understand that my consultant will be providing virtual platform-based consulting from a distant site and will ensure that my privacy is protected.

7. I understand that nobody else will be in the room with my consultant while meeting with me.

8. I understand that my consultant has no control over who is with me or in the same room as me at my location during the time of service.

9. I understand that virtual platform-based consulting sessions are billed as 60 minutes depending on what is applicable.

10. I have had a direct conversation with my consultant during which I had the opportunity to ask questions regarding the virtual platform-based consulting session. My questions have been answered and the risks, benefits and any practical alternatives have been discussed with me in a language in which I understand.

11. I understand that my consultant is willing to provide virtual platform-based consulting and that my insurance does not cover it; therefore, I understand that I'm responsible for the full cost of consulting services.

By signing this form, I certify:

That I have read or had this form read and/or had this form explained to me

That I fully understand its contents including the risks and benefits of virtual platform-based consulting

That I have been given ample opportunity to ask questions and that any questions have been answered to my satisfaction

If I am a danger to myself or others, you have my permission to contact the following person and disclose to them that I am a danger to myself or others and what my plan is to harm myself. I also agree that if I'm a danger to myself or others I will stay at the location that I'm at. (Please identify the following person):

Overview of Our Consulting Services: Our work together will focus on a collaborative approach, aimed at supporting you in reaching your objectives, recognizing your strengths and areas for growth, and creating strategies to overcome challenges and attain success. Consulting aims to provide you with advice and guidance on specific topics or issues, tailored to either individuals or organizations. Please note that consulting is distinct from therapy and does not involve diagnosing or treating mental health conditions.

Benefits/Outcomes: The consulting process aims to meet goals established collaboratively, usually addressing specific career development issues. Participating in consulting services may include benefits such as the resolution of work-related challenges, improved productivity, enhanced task management, and increased ability to address challenges related to current work situations, support for career change or advancement, job skill development, and adjustment to a new job. The process can lead to a greater understanding of professional goals and values, potentially increasing overall career satisfaction. Progress will be assessed regularly, and feedback from clients will be solicited to ensure the most effective consulting services are provided. There can be no guarantees made regarding the ultimate outcome of consulting.

Expectations: To reach consulting goals, it is essential that clients complete tasks assigned between sessions. Consulting is not a quick fix; it requires time and effort and may move slower than expected. During the consulting process, we identify goals, review progress, and adjust the plan as needed.

Risks: Achieving consulting benefits requires action. Although change is inevitable, it can be uncomfortable. Resolving issues and making changes in patterns may arouse unexpected reactions. Seeking to resolve problems can lead to discomfort and unintended relational changes. We will work collaboratively toward a desirable outcome; however, it is possible that the goals of consulting may not be reached. Ultimately, you are responsible for your own success.

Length of Consulting: Consulting sessions are typically weekly or biweekly, depending on the nature of the presenting challenges. It is difficult to predict how many sessions will be needed initially. We will collaboratively discuss from session to session the next steps and frequency of consulting sessions.

Communication Policy: We do not provide services through email or text. Assessments, advice, or consultations will not be conducted via written communication. We cannot ensure the confidentiality or quick response to all text messages, especially outside working hours. Due to the volume of messages, we ask that email and text communication be kept to a minimum. Text should only be used for last-minute scheduling issues (e.g., if you’re running late). Established clients can use encrypted email and/or a secure portal for messaging and appointment requests. For matters needing more than a brief reply, please schedule an appointment.

Standard Fees: Our rate is $200 per 60-minute session subject to change with prior notice. Appointments of varying lengths can be arranged and will be billed on a pro-rated basis. We request that you provide a credit card on file for my billing team to charge at the time of each session. The consultant charges their hourly rate in quarter hours for phone calls over 10 minutes in length, email correspondence, reading assessments or evaluations, writing assessments or letters, and collaborating with necessary professionals (with your permission). All costs for services outside of session will be billed to you and are due at the time of service. Exceptions to the standard fee rate are not guaranteed but may be evaluated, pending further consideration on behalf of the consultant and the client’s unique circumstances.

Overdue Payments: We reserve the right to use a collection agency to collect overdue payments.

Cancellation Policy: 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 within less than 24 business hours, the full session fee will be charged. We send statements only on request.

Termination: The consultant reserves the right to terminate the consulting relationship if more than two sessions are missed without proper notification.

Confidentiality: Information that a client shares with a consultant is completely confidential, except where otherwise specified by law. Information pertaining to a client’s record, or a client’s identity, cannot be released to any individual or agency outside of Fuller Living & Associates, LLC without the written consent of the client. For the purpose of gaining greater perspective, case scenarios may be shared within Fuller Living & Associates, LLC. I understand that Fuller Living & Associates will use email to communicate between offices and clients and that this entails some risk. Our internal billing and appointment-setting department will have access to your demographic and credit card information, which is required for processing of payment, coordinating sessions schedules, and any other routine matters. These individuals are not advised of your personal circumstances or your reason for pursuing consulting services.

Artificial Intelligence: In our consulting practice, we may use artificial intelligence (AI) platforms to improve efficiency and streamline processes (e.g., consolidating session notes, etc.) in a manner that is in accordance with our Privacy Policy. Any data used with AI will be de-identified to ensure your confidentiality and in a manner that is in accordance with our Privacy Policy. You have the right to request that AI not be used in your case at any time. Please let us know if you prefer to opt out of AI usage.

Client Responsibility for Privacy: Clients also bear the responsibility of ensuring privacy on their behalf. I enter appointments trusting that clients have ensured they are in a safe and private location. Consultants do not bear responsibility for any failure of clients to safeguard their own privacy.

Free Will: Our services are only available to clients who attend sessions of their own free will. We do not provide services for those under duress, court order, or for anyone, including minors, who do not wish to receive our services.

Age: Although our services are primarily tailored to adults, our consulting services are also available to those age 16 and over.

Mandated Reporting: By law, if the consultant determines that the safety of the client is in question or that the client has plans to harm any other person(s), the consultant is required to make a report to the proper authorities and the person(s) mentioned, if appropriate. Also, if the client discloses any information that could be interpreted as physical or sexual abuse to a child or vulnerable adult, the consultant is required to make a report to the proper authorities. A court of law may also require clinical records without a client’s consent.

By signing below, you acknowledge that you have read and understand the above information about our consulting services, agree to participate in these services of your own will, recognize that they are not a substitute for therapy or other medical or mental health treatment, and accept responsibility for your own success.

I hereby acknowledge that I am voluntarily participating in consulting services with Fuller Living and Associates LLC, and I hereby release and discharge Fuller Living and Associates LLC, its employees, agents, representatives, successors, and assigns (the "Released Parties") from any and all claims, demands, damages, causes of action, suits, or liabilities of any kind, including but not limited to personal injury, property damage, or wrongful death, arising out of or related to my participation in these services.

I acknowledge that participating in these services may involve physical, emotional, and psychological risks, and I accept that the Released Parties are not liable for any injuries or damages arising from my involvement.

I recognize that these services are not a replacement for therapy or medical or mental health treatment, and I accept full responsibility for my health and well-being both during and after coaching sessions.

I also understand that all information shared during consulting sessions is confidential, and I agree to uphold that confidentiality.

I acknowledge that the Released Parties do not make any promises, warranties, or assurances regarding the outcomes of consulting services, and any success I experience is entirely my own responsibility.

By signing below, I confirm that I have read, understood, and voluntarily agree to participate in the coaching or consulting services outlined above.

I/we authorize payment to Fuller Living & Associates, LLC for services rendered to myself and/or dependents.

I/we agree to be responsible for the costs of consulting services because they are not reimbursed by insurance companies. A copy of Fuller Living & Associates, LLC Privacy Disclosure Statement is available to you and has been offered to you. I have read and understand the information presented in this form.

Privacy Practices

Client Privacy Statement: This notice informs you of how your medical information may be used and disclosed and how you can get access to this information. Please review it carefully and ask questions if needed. This Notice is effective August 1st, 2015 and governs our practices on and after that date. Fuller Living & Associates, LLC and it's contractors are required to protect the privacy of your Protected Health Information (PHI). We are required by the Health Insurance Portability and Accountability Act (HIPAA) to provide you with a notice of our legal obligations and privacy practices with respect to PHI. The terms we, our, and us refer to (Fuller Living) and the terms you and your refer to the client.

Notice Information: This Notice of Privacy Practices describes how we may use and disclose your PHI to carry out services and for other purposes that are specified by law. We reserve the right to change this notice. The changes will apply for PHI we already have about you and PHI we receive about you in the future. We will provide an updated Notice to you if you request one. If you have questions about this Notice, our privacy practices, or the Fuller Living services this Notice applies to, please contact us at 763-647-8188 or speak with your consultant directly.

Protected Health Information: Protected Health Information (PHI) is: 1. Information about your mental or physical health, related health care services, or payment for health care services. 2. Information that is provided by you, created by us, or shared with us by related organizations. 3. Information that identifies you or could be used to identify you, such as demographic information, address & phone number, social security number, age, date of birth, dependents, and health history. Except as described in this Notice or specified by law, we will not use or disclose your PHI. We will use reasonable efforts to request, use, and disclose the minimum amount of PHI necessary. Whenever possible, we will deidentify: you or encrypt your personal information so that you cannot be personally identified. We have put physical, electronic, and procedural safeguards in place to protect your PHI and comply with federal and state laws.

Your Rights

Request confidential communication: You may ask us to communicate with you using alternative means or alternative locations. For example, you may ask us to contact you only in writing or at a different address than the one in your file. Your request must be made in writing and state how and when you would like to be contacted. You do not have to tell us why you are making the request, but we may require you to make special arrangements for payment or other communications. We will review and grant reasonable requests, but we are not required to agree to any restrictions.

Session Documentation: We use a HIPAA-compliant client portal to record essential notes documenting key aspects of our consulting sessions. This helps track progress, manage logistics, and plan for future sessions. You have the right to request a copy of these notes at any time. Please note, a fee will be charged to cover the time (on a pro rated session rate) and for any resources required to fulfill your request (e.g., postage, etc.).

Your Written Permission: We obtain your written permission (authorization) before using or disclosing your PHI for purposes other than those provided above, or as otherwise permitted or required by law. If you do not want to authorize a specific request for disclosure, you may refuse to do so without fear of reprisal. You may withdraw your permission. If you do provide your written authorization and then later want to withdraw it, you may do so in writing at any time. As soon as we receive your written revocation, we will stop using or disclosing the PHI specified in your original authorization, except to the extent that we have already used it based on your written permission.

Under 18-Years-Old: If you are under 18, you may request that information about you be kept from your parents. You must give us your request in writing, describe the information, and tell us why you don't want your parents to see it. If, after reviewing your request, Fuller Living staff believes that giving information to your parents is not in your best interest, we will not share the information. If Fuller Living staff believes this information could be safely shared with your parents, we will inform you of that decision. If you are at least 16, you may ask for services without the consent of your parents, but you may have to pay for the services if you do not want your parents to know.

Your information will be encrypted.

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