Practice Policies and Consent

PRACTICE POLICIES AND CONSENT

APPOINTMENTS AND CANCELLATIONS

I agree to attend each session scheduled. If something arises and I am unable to attend, I will contact the practitioner 48 hours in advance. 

If I have signed up for a program, I agree to complete the entire program through it's duration. I agree to attend all sessions for each program.

I agree to have my card on file and am aware that my card will be charged per program or the arranged payment plan.

TELEPHONE ACCESSIBILITY

I am not available by phone. If a true emergency situation arises, please call 911. If at any time you are feeling suicidal please call The National Suicide Prevention Lifeline at 1800-273-8255 or the local Mobile Crisis Hotline at 1888-573-1006.

ELECTRONIC COMMUNICATION

I cannot ensure the confidentiality of any form of communication through electronic media. If you prefer to communicate via email for issues regarding scheduling or cancellations, I will do so. While I may try to return messages in a timely manner, I cannot guarantee immediate response and request that you do not use these methods of communication to discuss content and/or request assistance for emergencies. You can email me at Kara@letsdiscoveryourwings.com

The practitioner/client relationship is unique in that it is a highly personal and at the same time, a contractual agreement. Given this, it is important for us to reach a clear understanding about how our relationship will work, and what each of us can expect. This consent will provide a clear framework for our work together. Feel free to discuss any of this with me. Please read and indicate that you have reviewed this information and agree to it by signing and dating at the bottom.

The Process

You have taken a very positive step by deciding to attend this program. The outcome of this program depends largely on your willingness to engage in this process. I cannot promise that your behavior or circumstance will change. I can promise to support you and do my very best to understand you and repeating patterns, as well as to help you clarify what it is that you want for yourself.

Confidentiality

The session content and all relevant materials to the client’s program will be held confidential unless the client requests in writing to have all or portions of such content released to a specifically named person/persons. Limitations of such client held privilege of confidentiality exist and are itemized below:

1. If a client threatens or attempts to commit suicide or otherwise conducts him/her self in a manner in which there is a substantial risk of incurring serious bodily harm.
2. If a client threatens grave bodily harm or death to another person.
3. If the practitioner has a reasonable suspicion that a client or other named victim is the perpetrator, observer of, or actual victim of physical, emotional or sexual abuse of children under the age of 18 years.
4. Suspicions as stated above in the case of an elderly person who may be subjected to these abuses.
5. Suspected neglect of the parties named in items #3 and # 4.
6. If a court of law issues a legitimate subpoena for information stated on the subpoena.
7. If a client is receiving services or being treated by order of a court of law, or if information is obtained for the purpose of rendering an expert’s report to an attorney.

Occasionally I may need to consult with other professionals in their areas of expertise in order to provide the best program for you. Information about you may be shared in this context without using your name.

If we see each other accidentally, I will not acknowledge you first. Your right to privacy and confidentiality is of the utmost importance to me, and I do not wish to jeopardize your privacy. However, if you acknowledge me first, I will be more than happy to speak with you.

If there is a dispute that cannot be resolved with the client and practitioner, the client will agree to mediation as a way to resolve the dispute.  

BY SIGNING AND DATING BELOW I AGREE TO THESE TERMS…..

Discover Your Wings Counseling