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DISCLOSURE, TREATMENT, & FEE AGREEMENT THERAPIST NAME: Adrian Ring, MA, NCC SUPERVISOR: Jamie Blair Chavarría, LCSW License 194, LEFT License 831 DEGREES: M.A. in Counseling Psychology Counselor
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How to fill out Disclosure Statement - ADRIA:

01
Begin by obtaining a copy of the Disclosure Statement - ADRIA form. This form can typically be found on the website of the Alberta Dispute Resolution Institute (ADRIA) or by contacting them directly.
02
Fill in the header section of the form with the necessary information, including your name, contact details, and the name of the dispute resolution process or program this disclosure statement is for.
03
Provide a brief overview of your background and experience in dispute resolution. Include any relevant qualifications, certifications, or training that you have received.
04
Outline your areas of expertise and specialization in dispute resolution. This may include specific types of disputes or industries you have experience working in.
05
Indicate any involvement you have in ongoing disputes or any pending legal or disciplinary actions related to dispute resolution.
06
Describe any conflicts of interest that may exist or may arise during the dispute resolution process. It is important to be transparent about any relationships, financial interests, or personal connections that could potentially impact your ability to remain unbiased and impartial.
07
Disclose any fees, charges, or financial arrangements related to your dispute resolution services. Provide clear details about your pricing structure, payment terms, and any additional costs that may be incurred.
08
Finally, sign and date the Disclosure Statement - ADRIA form to confirm that all the information provided is true and accurate to the best of your knowledge.

Who needs Disclosure Statement - ADRIA?

01
Individuals who are professional dispute resolution practitioners, such as mediators or arbitrators, and are involved in formal dispute resolution processes.
02
Organizations or programs that require dispute resolution practitioners to disclose their qualifications, experience, conflicts of interest, and financial arrangements.
03
Parties engaged in a dispute resolution process who want to ensure transparency and have access to relevant information about the dispute resolution practitioner overseeing their case.
04
Anyone seeking dispute resolution services and wants to make an informed decision about the practitioner they choose to work with.
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The disclosure statement - adria is a document that discloses relevant financial information and potential conflicts of interest for individuals in a particular industry or position.
Individuals in specific positions or industries that are required by law or policy to disclose financial information and potential conflicts of interest must file a disclosure statement - adria.
The disclosure statement - adria typically requires individuals to provide detailed information about their financial holdings, sources of income, and potential conflicts of interest. It is important to carefully review the instructions provided and accurately complete all required sections.
The purpose of the disclosure statement - adria is to promote transparency, accountability, and integrity by ensuring that individuals in specific positions or industries disclose relevant financial information and potential conflicts of interest.
The disclosure statement - adria typically requires individuals to report their financial holdings, sources of income, gifts or benefits received, and any potential conflicts of interest that may arise from their position or industry.
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