Email: naomi@naomiberrycounseling.com Website: naomiberrycounseling.com Phone: 480-427-3553Informed Consent for Psychotherapy Services • October 23rd, 2017
Welcome! I look forward to working with you. I know that starting therapy is a major decision and you may have many questions. The purpose of this document is to inform you about my counseling services and business policies. Please read this agreement very carefully. The Arizona State Board of Behavioral Health Examiners requires that I obtain your signature acknowledging that I have provided you with this information. You may ask questions about any of these procedures at any time. When you sign this document, it also represents an agreement between us. You may revoke this agreement or any other agreement at any time. You will need to submit your revocation to me in writing either in person or by certified mail.
Beverlee Laidlaw Chasse, MC, LPCInformed Consent for Psychotherapy Services • August 7th, 2018
This document contains important information about the counseling services and business policies of Beverlee Laidlaw Chasse LPC. Please read this agreement very carefully. The Board of Behavioral Health Examiners requires that I obtain your signature acknowledging that I have provided you with this information. You may ask questions about any of these procedures at any time. When you sign this document, it also represents an agreement between us. You may revoke this agreement or any other agreement at any time. You will need to submit your revocation in writing.
Michael J. Maxwell, PhD, LPC-S, NCCInformed Consent for Psychotherapy Services • December 15th, 2013
CONFIDENTIALITY: All information disclosed within sessions and the written records pertaining to those sessions are confidential and may not be revealed to anyone without your written permission except where disclosure is required by law.
Psychological ServicesInformed Consent for Psychotherapy Services • April 6th, 2018
This document contains important information about the counseling services and business policies of Holli Adsit LMSW,LISAC with Healing Spirit Counseling, LLC. Please read this agreement very carefully. The Board of Behavioral Health Examiners requires that I obtain your signature acknowledging that I have provided you with this information. You may ask questions about any of these procedures at any time. When you sign this document, it also represents an agreement between us. You may revoke this agreement or any other agreement at any time. A revocation will not apply to past agreements, only to change the future interactions. You will need to submit your revocation in writing.
