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Catherine Cope, MA, LPC 135 Cherry Street Asheville, NC 28801 8285453120 PROFESSIONAL DISCLOSURE STATEMENT Information and Consent The following information is designed to inform you of my background
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Point by point instructions for filling out a COPE Professional Disclosure Statement document:
01
Begin by carefully reading all the instructions provided on the COPE Professional Disclosure Statement document. Make sure you understand what information needs to be included and any specific formatting requirements.
02
Start by providing your personal information, including your full name, contact information, and professional credentials. This is important for identifying yourself and allowing others to reach you if necessary.
03
Include a clear and concise summary of your professional background and experience. This should cover your education, qualifications, certifications, and any relevant professional affiliations.
04
Disclose any conflicts of interest that may exist. These could include financial interests, relationships with organizations or individuals that may present a conflict of interest, or any other factors that could potentially impact your objectivity or professional judgment.
05
Specify the scope of your professional practice. This includes describing the types of services you offer, your areas of expertise, and any limitations or restrictions that may apply.
06
Provide information about your fees, billing practices, and any insurance coverage you accept. Be transparent about how you charge for your services and any payment arrangements or options available to clients.
07
Include a section dedicated to disclosing any potential risks or benefits associated with your services. This may involve explaining the potential outcomes or consequences that clients should be aware of before engaging in your services.
08
If applicable, mention any privacy or confidentiality policies you have in place to protect client information. Assure clients that their personal information will be handled securely and in accordance with relevant laws and regulations.
09
Review and proofread your completed COPE Professional Disclosure Statement document to ensure accuracy and clarity. Make any necessary corrections or edits before finalizing and submitting it.

Who needs a COPE Professional Disclosure Statement document?

01
Mental health professionals, such as psychologists, psychiatrists, therapists, counselors, and social workers, who provide individual or group therapy, counseling, or psychological evaluations.
02
Educational professionals, such as school counselors or psychologists, who work with students and families to address academic, emotional, or behavioral concerns.
03
Professionals in other fields, such as marriage and family therapists, career counselors, and life coaches, who offer guidance, support, and counseling services in their respective specializations.
It is essential for these professionals to provide a COPE Professional Disclosure Statement document to their clients or patients to ensure transparency, promote informed consent, and establish a professional framework for the therapeutic or counseling relationship.
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