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PROFESSIONAL DISCLOSURE STATEMENT AND AGREEMENT FOR CLINICAL SUPERVISION for Michelle L. Dean, MA, AT RBC, LPC, CAP, HLM (DATA) LANDOWNER LOCATION: 42 Winder mere Ave. Landowner, PA 19050 MAINLINE

How to fill out professional disclosure statement

How to fill out a professional disclosure statement:

1. Begin by collecting all the necessary information about yourself, such as your name, contact details, professional qualifications, and experience.
2. Clearly state the purpose of the disclosure statement and provide a brief introduction about your professional background.
3. Include any relevant licenses, certifications, or accreditations that you hold in your field.
4. Provide a detailed description of the services you offer and the areas in which you specialize.
5. Include a section on your professional memberships or affiliations, highlighting any industry organizations or associations you belong to.
6. Outline any past or present conflicts of interest that may affect your ability to provide objective and unbiased advice.
7. Include a section on any fees or compensation structures that clients can expect when engaging your services.
8. If applicable, provide information on any legal or regulatory requirements specific to your profession, such as disclosure of financial interests or conflicts with clients.
9. Clearly indicate how clients can contact you for further information or to address any concerns or questions they may have.
10. Proofread the disclosure statement thoroughly to ensure accuracy and clarity of information.

Who needs a professional disclosure statement:

1. Professionals in certain fields, such as financial advisors, lawyers, therapists, and consultants, may be required by law or regulations to provide a professional disclosure statement to clients.
2. Individuals or companies seeking professional services or advice may request a professional disclosure statement to assess the qualifications and expertise of the provider before entering into a contract or agreement.
3. Professional organizations or associations may require their members to have a professional disclosure statement as part of their code of ethics or standards of practice.
4. Professionals who wish to establish transparency and build trust with their clients may choose to voluntarily create and provide a professional disclosure statement.

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