Client Consent Form

Please read the following policies carefully. Your signature is required at the end to indicate your acceptance of the terms and conditions of your engagement in counseling. Whenever changes are made to this policy, a revised Client Consent Form will be provided to you for your signature.

ATTENDANCE

Regular attendance at scheduled sessions is expected and is vital to you having greatest benefit from counseling.

CANCELLATION OF SESSIONS

Notice of cancellation must be given to the counselor at least 24 hours before the scheduled session. Failure to comply with this requirement, or to reschedule in the same week in which service was reserved, will incur a charge.

PAYMENT

Payment for services is due prior to the scheduled start of each session. Your rate is the dollar amount that is agreed with your counselor at the start of services. Any changes in rates because of demand and the cost of doing business, will be communicated at least one month prior to your next session.

CONFIDENTIALITY

All information obtained, generated, or documented in the course of providing counseling is held in confidence by HELPING’U’THRIVE clinicians, with the following exceptions:

a. Threat of serious harm to self or others

b. Reasonable suspicion of child abuse, or neglect or abuse of a child, or of an incapacitated or dependent adult

c. Court order

d. Voluntary release signed by client

e. Consultation with other professionals, as consented to by client.

SOCIAL MEDIA/INTERNET BOUNDARY‍ ‍

Confidentiality and the maintenance of professional boundaries are critical in the delivery of services. This is ensured by clinicians having no social contact with clients outside of the designated session, or on any social media sites. Beyond the initial search which clients undertake to identify a provider, any other internet search will be considered stalking.

CLIENT CONSENT TO TREATMENT

I have read the above information and fully understand it. I consent to counseling with the counselor(s) at Helping’U’Thrive, under the terms described above, and recognize that I have the right to terminate counseling at any time. My signature below is an acknowledgement that I have read and agree to the policies above.