COUNSELING AGREEMENT. As a counselee, I understand the following:
COUNSELING AGREEMENT. The purpose of this section is to obtain your con- sent to participate in telemental health, which involves counseling by phone, video, or secure online email portal.
COUNSELING AGREEMENT. This agreement for services will remain effective until , or until ended by agreement between you and your counselor. If you have missed a scheduled visit, and you do not call our office within seven (7) days, your counselor will accept that as your notice that you have terminated this agreement and that you wish to discontinue counseling with our office. I/we have read the Professional Disclosure Statement (pages 1-2), the Business Policy (pages 3-4), and accept the policies described. I/we understand that I/we am/are financially responsible for services rendered and that my/our account is due in full at each session. I/we understand that ACG does not accept assignments of benefits from insurance carriers. I/we understand that I/we will be charged for the full time reserved in my/our behalf, should I/we miss an appointment or not provide a 48 (forty-eight) hours notice of cancellation of an appointment. I/we also understand that there is a $40.00 service charge for each returned check. I/we hereby grant my/our permission for any therapy, testing, or diagnostic evaluation that may be deemed pertinent in the counseling of myself/ourselves, my/our marriage, or my/our family. I/we authorize the release of any therapy information necessary to process insurance claims for my/our treatment, and the release of the therapy sessions information with other therapy personnel. The therapy sessions and records are strictly confidential except where state law requires the reporting of threats of violence, harm, or child abuse and neglect (from evidence or suspicion), and when information is subpoenaed by the courts. Any request for the disclosure of your therapy records by a third party (other than by reason of a court issued Subpoena) will require a written authorization signed by you pursuant to a format that is in compliance with HIPPA regulations. Being aware that there may be a potential for emotional strains, stresses, and life changes as a result of therapy, I/we agree to enter the therapy process. I/we understand that ACG and Xxxxxx Xxxxxxxx are not an emergency service and does not guarantee any particular results or outcome from the therapy process. If you have any questions, feel free to ask. Please print a copy of this form and sign/date the “Signature Page” of this document as well as initialing each page at the bottom right corner (gray box is for therapist initials). I will return this copy of the professional disclosure and will retain the “Signature Pag...
COUNSELING AGREEMENT. It is agreed that the client shall make a good faith effort at personal growth and engage in the counseling process as an important priority at this time in his/her life. This process is not always easy, and sometimes a client’s symptoms may worsen before improving. Suspension, termination or referral shall be discussed between counselor and client for a pattern of behavior that reveals disinterest or lack of commitment to counseling or for any unresolved conflict or impasse between counselor and client.
COUNSELING AGREEMENT. The purpose of this form is to obtain your consent to participate in telemental health, which involves counseling by phone, video, or secure online email portal.
COUNSELING AGREEMENT. If you are interested in receiving biblical counseling at FBC, please read and sign the following statement. The biblical counselors at FBC are available to take a limited number of counseling cases. Our counselors (by design) are not certified by the state of IN; rather, they have received or are receiving extensive training in biblical counseling. Our primary counselors are certified by or are in the process of becoming certified by the Association of Certified Biblical Counselors (ACBC, formerly NANC: The National Association of Nouthetic Counselors). If you seek counseling at FBC, we want you to know that all counseling will be conducted in accordance with the counselor’s understanding of the Scriptures. Your counseling will be biblical, meaning that the Bible will be the authority in all cases. If you are not sure that you will be interested in biblically based counseling, you may first attend one or two sessions to better understand what biblical counseling is like. If you are unwilling to use the Bible as the final authority or are unwilling to do the assigned homework, the sessions will be terminated. If you attend a church other than FBC, we encourage you to invite your pastor or another leader from your church to accompany you to the counseling sessions. We recognize and respect the authority and discipline of your church. The attendance by your pastor or other leader will make the transfer back to the pastoral care of your church much easier. If you are not attending a church, or if your pastor or another leader from your church does not accompany you to the counseling sessions, or if your church is not structured or willing to provide the kind of counseling received at FBC, we will expect you to attend FBC on a weekly basis while you are in counseling here. Lasting change is more effectively realized when people also receive help from the church’s ministry of preaching, teaching, and fellowship and when those ministries complement the help given in counseling. Confidentiality is practiced in our counseling sessions; however, absolute confidentiality is not scriptural. In certain circumstances, the Bible requires that facts be disclosed to select others (Xxxxxxx 18:15ff). If your church leadership should inquire, we will disclose to them only the information that we believe is necessary for them to effectively and biblically fulfill their responsibility to shepherd you. If you have a problem with this procedure, please discuss your concerns and ...
