Get the free professional disclosure statement - dhmh maryland

SAMPLE FOR LICENSED GRADUATE PROFESSIONAL COUNSELORS PROFESSIONAL DISCLOSURE STATEMENT In accordance with the Annotated Code of Maryland Health Occupations 17-308 Authority granted by license 17-309 Supervised clinical practice and 17-507 Professional disclosure statement John Doe M.

How to fill out professional disclosure statement

How to fill out counselor professional disclosure statement:

1. Start by providing your personal information, including your full name, contact information, and professional credentials.
2. Next, include a brief biography or summary of your education, training, and experience as a counselor.
3. List any specialized certifications or areas of expertise that you possess.
4. Include information about your therapeutic approach or the theoretical frameworks that guide your counseling practice.
5. Provide details about your fees and payment policies, including any accepted insurance plans or sliding scale payment options.
6. Include information about your office location and hours of operation.
7. Explain your confidentiality policy and any limitations to confidentiality.
8. Include information about your cancellation and rescheduling policies.
9. Provide contact information for emergencies or after-hours support.
10. Make sure to review and sign the statement before distributing it to clients.

Who needs counselor professional disclosure statement:

1. Counselors who are licensed or registered to practice therapy.
2. Mental health professionals who work independently or in private practice.
3. Counselors who offer their services to clients on a fee-for-service basis.
4. Counselors who work in agency settings may also be required to provide a professional disclosure statement to clients.

People Also Ask about

What is a professional disclosure statement in counseling?

The professional disclosure statement (PDS) is a document that an LPC, LMFT, or registered associate gives to each client that provides information about the licensee/registered associate and their practice. Who must have a PDS? Every applicant for licensure must submit a PDS as part of his or her application.

How do you write a disclosure statement for a therapist?

The following items are often included: Contact info. Your qualifications including training, experience, licensure and certifications. Professional associations that you belong to. Any limitations on your practice such as being under supervision. Services offered. Your theoretical foundation and counseling approach.

Which of the following should be included in a professional disclosure statement?

What is the The Professional Disclosure Statement? The name, title, business address, and business telephone number of the professional clinical counselor, professional counselor,

What is an example of a therapy disclosure statement?

I give my consent for treatment as outlined in this Disclosure Statement. I, the client, understand that I am free to terminate the treatment process at any time by giving appropriate notice with respect to the therapeutic relationship established and the cancellation policy mentioned above.

What is an example of a professional disclosure statement?

I will keep confidential anything that you say to me, with the following exceptions: a) you direct me to tell someone else, b) I determine that you are a danger to yourself or others, c) I am ordered by a court to disclose information, d) I suspect or am made aware of physical/sexual abuse of minors, persons with

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What is professional disclosure statement?

A professional disclosure statement is a document provided by professionals, such as therapists or counselors, that outlines their qualifications, services, and potential conflicts of interest to inform clients about the nature of the professional relationship.

Who is required to file professional disclosure statement?

Professionals in fields such as therapy, counseling, psychology, and social work are typically required to file a professional disclosure statement to ensure transparency and ethical practices.

How to fill out professional disclosure statement?

To fill out a professional disclosure statement, a professional should include their qualifications, licensure information, specialties, service fees, confidentiality policies, and any potential conflicts of interest.

What is the purpose of professional disclosure statement?

The purpose of a professional disclosure statement is to provide clients with essential information about the professional's credentials, services, and ethical considerations, promoting informed consent and trust.

What information must be reported on professional disclosure statement?

Information that must be reported on a professional disclosure statement includes the professional's education, licenses, areas of expertise, treatment philosophy, fees, confidentiality practices, and any dual relationships or conflicts of interest.