Common use of Client Contact Clause in Contracts

Client Contact. Your therapist may need to communicate with you by telephone or other means. Please indicate your preference by checking one of the choices listed below. Please be sure to inform your therapist if you do not wish to be contacted at a particular time or place, or by a particular means. My therapist may call me on my home phone. My home phone number is: ___ _ _ _ _ _ __ My therapist may call me or text my cell phone. My cell phone number is: ___ _ _ _ _ _ _ _ _ _ My therapist may call me at work. My work phone number is: ___ _ _ _ _ _ _ _ _ _ _ My therapist may communicate with me by e-mail. My e-mail address is: ___ _ _ _ _ _ _ _ _ _ My therapist may send a fax to me. My fax number is: _____________________ Consultation: I consult regularly with other professionals regarding my clients in order to provide you with the best possible service. Names or other identifying information are never mentioned; client identity remains completely anonymous and your confidentiality will be fully maintained. If, for some reason, I believe it is important to consult with another professional in-depth, and I believe identifying information about you may be shared, I will have you sign a release of information allowing me to share this information. Without such a release, I will not consult with another professional providing information that might lead another person to be able to identify you. Release of Information: Considering all of the above exclusions, upon your request and with your written consent, I may release limited information to any person/agency you specify, unless I conclude that releasing such information might be harmful to you. If I reach that conclusion, I will explain the reason for denying your request.