Colorado Law requires that the following information be provided to all clients.
The Colorado Department of Regulatory Agencies has the general responsibility of regulating the practice of licensed psychologists, licensed social workers, licensed professional counselors, licensed marriage and family therapists, licensed school psychologists practicing outside the school setting, and unlicensed individuals who practice psychotherapy. The agency within the Department that has responsibility specifically for licensed and unlicensed psychotherapists is:
Department of Regulatory Agencies Mental
Health Section
1560 Broadway, Suite 1350
Denver, CO 80202
(303) 894-7766
If there are any complaints or concerns regarding the practice of mental health, please direct them to the above-listed department. Any person who alleges that a mental professional has violated the licensing laws related to the maintenance of records of a client eighteen years of age or older, must file a complaint or other notice with the licensing board within seven years after the person discovered or reasonably should have discovered this. Pursuant to law, this practice will maintain records for a period of seven years commencing on the date of termination of services or on the date of last contact with the client, whichever is later. When the client is a child, the records must be retained for a period of seven years commencing either upon the last day of treatment or when the child reaches eighteen years of age, whichever comes later, but in no event shall records be kept for more than twelve years.
Information regarding your clinician’s training and licensure is attached to the end of this disclosure.
You are entitled to receive information from me regarding methods, techniques, fee structure and duration (if known) of the sessions. You have the right to seek a second opinion from another therapist or terminate therapy at any time.
The information provided by you during counseling is legally confidential except as required by law and is privileged communication and cannot be disclosed in any court of competent jurisdiction in the State of Colorado without the consent of the person to whom the testimony sought relates. If the information is legally confidential, the therapist cannot be forced to disclose the information without the client's consent. There are exceptions to the rule of confidentiality that can be explained and will be identified to you should any situations arise during therapy.
Some of these exceptions are listed in section C.R.S. 12-43-218 and C.R.S. 27-65- 102(4.5) and in the Notice of Privacy Rights you were provided. In general, the exceptions include a “danger to yourself or others” as in the case of child abuse, suicide, gravely disabled C.R.S 27-65-102(9); under a court order; or in response to any legal action taken by you against this agency. You should also be aware that provisions concerning disclosure of confidential communications shall not apply to any delinquency or criminal proceedings, except as provided in section 13-90-107
C.R.S. C.R.S. 18-6.5-108 requires the reporting of abuse and exploitation of elders, 70 years of age or
older.
In the event that the therapist becomes concerned about a client’s safety or welfare, it is policy that the therapist be allowed to request a welfare check through law enforcement.
In a professional relationship, sexual intimacy is never appropriate and should be reported to the board that licenses, registers, or certifies the licensee, registrant or certificate holder.
You should know that the clinicians detailed on the attached addendum may provide consultation to each other. Information about you may be shared in this context without using your name. Information regarding your case may be made available to staff of Highlands Integrative Pediatrics as is warranted for administrative and/or clinical care coordination.
As to the regulatory requirements applicable to mental health professionals: a Licensed Clinical Social
Worker, a Licensed Marriage and Family Therapist, and a Licensed Professional Counselor must hold a
master’s degree in their profession and have two years of post-master’s supervision. A Licensed
Psychologist must hold a doctorate degree in psychology and have one year of post-doctoral supervision.
A Licensed Social Worker must hold a master’s degree in social work. A Psychologist Candidate, a
Marriage and Family Therapist Candidate, and a Licensed Professional Counselor Candidate must hold
the necessary licensing degree and be in the process of completing the required supervision for licensure.
A Certified Addiction Counselor I (CAC I) must be a high school graduate, and complete required
training hours and 1000 hours of supervised experience. A CAC II must complete additional required
training hours and 2,000 hours of supervised experience. A CAC III must have a bachelor’s degree in
behavioral health, and complete additional required training hours and 2,000 hours of supervised
experience. A Licensed Addiction Counselor must have a clinical master’s degree and meet the CAC III
requirements. A Registered Psychotherapist is registered with the State Board of Registered
Psychotherapists, is not licensed or certified, and no degree, training or experience is required. However,
the registered psychotherapist is listed in the State's database and is authorized by law to practice
psychotherapy in Colorado but is not licensed by the state and is not required to satisfy any standardized
educational or testing.
I understand I am responsible for all fees agreed to in the financial agreement. Fees are due upon receipt of
services, and should billing attempts fail, delinquent accounts will be turned over to a collection agency.
Clinicians employed by Highlands Integrative Pediatrics are carefully selected for their expertise, skills,
and experience in the work of providing high quality professional psychotherapy and counseling. We
encourage on-going professional development, which is also a requirement by the Department of
Regulatory Agencies for the maintenance of professional licenses and credentials. By initialing this
document, you acknowledge that you have been informed of your therapist’s degrees, credentials and
licenses.