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Counselor Disclosure Form
WAC 246810
Gabriele M. Smith, MA, LPC, NCC
203 SE Park Plaza Dr. ×105
Vancouver, WA 98684
3607188544Licensed Professional Counselor #LH60078778Type of Counseling trained
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How to fill out counselor disclosure form

How to fill out a counselor disclosure form:
01
Gather all necessary information: Start by collecting all the information required to fill out the counselor disclosure form. This may include personal details, contact information, professional qualifications, and any other relevant information requested on the form.
02
Read the instructions carefully: Take the time to thoroughly read and understand the instructions provided with the counselor disclosure form. This will ensure that you accurately complete the form and provide all the necessary information.
03
Complete the personal details section: Begin by filling out the personal details section of the form. This typically includes your name, address, phone number, email address, and any other pertinent information.
04
Provide education and professional qualifications: Enter your educational background and any professional qualifications or certifications you hold. This may include your degree, licenses, or relevant training.
05
Disclose relevant experience: Provide details of your work experience relevant to counseling. This may include previous employment, internships, volunteer work, or any other experience that showcases your counseling skills and expertise.
06
Include references: Many counselor disclosure forms require references. Make sure to include the contact information of individuals who can attest to your professional capabilities and character. This is typically done to verify your qualifications and credibility.
07
Sign and date the form: Once you have completed all the necessary sections, carefully read the form once more to ensure its accuracy. Then, sign and date the form in the designated area to indicate that the information provided is true and accurate to the best of your knowledge.
Who needs counselor disclosure forms:
01
Counselors: Professional counselors, including therapists, psychologists, social workers, and other mental health professionals, often need to fill out counselor disclosure forms. These forms are typically required by licensing boards, employer organizations, or government agencies to ensure transparency and accountability in the counseling profession.
02
Job applicants: Individuals who are applying for counseling positions or internships may be required to complete counselor disclosure forms. This allows potential employers to assess the applicant's qualifications, experience, and ethical standing before making hiring decisions.
03
Students: Aspiring counselors who are in training or studying counseling-related fields may be required to complete counselor disclosure forms as part of their educational programs. This helps educational institutions to track and evaluate students' progress, ethics, and readiness for professional practice.
In summary, filling out a counselor disclosure form involves gathering necessary information, carefully reading the instructions, completing personal details, education, and experience sections, providing references, and signing and dating the form. These forms are typically required by counselors themselves, job applicants, and counseling students to ensure transparency and accountability in the counseling profession.
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What is counselor disclosure form?
The counselor disclosure form is a document that counselors must fill out to disclose any potential conflicts of interest or financial relationships with clients.
Who is required to file counselor disclosure form?
Counselors are required to file the counselor disclosure form.
How to fill out counselor disclosure form?
Counselors can fill out the counselor disclosure form by providing accurate information about any potential conflicts of interest or financial relationships with clients.
What is the purpose of counselor disclosure form?
The purpose of the counselor disclosure form is to ensure transparency and maintain trust between counselors and clients.
What information must be reported on counselor disclosure form?
Counselors must report any potential conflicts of interest or financial relationships with clients on the counselor disclosure form.
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