Clinical Concent | HOPE Counseling & Consulting Services, Inc.

Client Consent for Clinical Services

COUNSELING is a confidential process designed to help you address your concerns, come to a greater understanding of yourself, and learn effective personal and interpersonal coping strategies. It involves a relationship between you and a trained therapist who has the desire and willingness to help you accomplish your individual goals. Counseling Involves sharing sensitive, personal. and private information that may at times be distressing. During the course of counseling. there :nay be periods of increased anxiety or confusion. The outcome of counseling is often positive; however. the level of satisfaction for any individual is not predictable. Your therapist is available to support you throughout the counseling process.

CONFIDENTIALITY:

All interactions with Counseling Services, including scheduling of or attendance at appointments, content of your sessions, progress in counseling, and your records are confidential. No record of counseling is contained in any academic, educational, or job placement file. You may request in writing that the counseling staff release specific information about your counseling to persons you designate.

EXCEPTIONS TO CONFIDENTIALITY:

The counseling staff works as a team. Your therapist may consult with other counseling staff to provide the best possible care. 'I'hese consultations are för professional and training purposes.
If there Is evidence of the clear and imminent danger of harm to self and/or others, a therapist is legally required to report this information to the authorities responsible for ensuring safety.
A court order, issued by a judge, may require the Counseling Services staff to release information contained in records and/or require a therapist to testify in a court hearing.

Should emergency medical services be needed from a physician or hospital you have the right to seek help where available / needed. We appreciate prompt arrival for appointments. Twenty-four hour notice of cancellation allows us to use the time för others. I have read and discussed the above information with my therapist. I understand the risks and benefits of counseling, the nature and limits of confidentiality, and what is expected of me as a client of the Counseling Services.

Date:

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw Signature
Type In Signature

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Adopt & Sign

Signed by Linda McRae
Signed On: February 15, 2024

Timestamp

Audit

July 13, 2021 6:04 pm EDT

Client Consent for Clinical Services Uploaded by Linda McRae - info@thereishopeinc.com IP 199.30.185.69

November 3, 2021 3:05 pm EDT

Linda McRae - info@thereishopeinc.com added by Linda McRae - info@thereishopeinc.com as a CC'd Recipient Ip: 73.127.40.137