Get the free Courtney's Counselor Disclosure Statement 2.docx

Counselor Disclosure Information Counselor Name: Courtney S. Wick MS, LEFT, CDT State of Washington Marriage and Family Therapy Associate License#: MG60296126 Chemical Dependency Professional Trainee

How to fill out courtneys counselor disclosure statement

Courtney's counselor disclosure statement is typically needed by licensed counselors or therapists who provide professional counseling services. This statement allows the counselor to disclose important information to their clients regarding their qualifications, therapeutic approach, and any potential risks or limitations of the counseling services.

To fill out Courtney's counselor disclosure statement, follow these steps:

1. Begin by providing your personal and contact information, including your name, address, phone number, and email address. This information will help clients reach out to you if needed.
2. Next, you should include your professional qualifications. List any degrees, certifications, or licenses that you hold, along with the name of the issuing institution and the year of completion. This section is important as it establishes your credibility and expertise in the field.
3. Describe your therapeutic approach and the methods or techniques you commonly use in your counseling practice. Whether you follow a specific theoretical orientation or have a unique approach, make sure to explain it in clear and understandable terms. This is essential because it allows clients to understand what to expect from their counseling sessions.
4. Include a section that outlines your fees and the payment methods you accept. Be transparent about your rates and whether you offer any sliding scale options or accept insurance. This will allow clients to understand the financial aspect of your counseling services.
5. Provide a list of any relevant policies or procedures that clients should be aware of, such as cancellation policies, confidentiality guidelines, or any limitations on your services. This section ensures that clients understand your expectations and rights as a counselor.
6. Finally, include a space for the client's signature to acknowledge receipt and understanding of the disclosure statement. This demonstrates that they have reviewed the information provided and agree to proceed with counseling services.

Remember to regularly review and update your counselor disclosure statement to reflect any changes in your practice or professional qualifications. By filling out Courtney's counselor disclosure statement thoroughly and accurately, you ensure that potential clients have all the necessary information to make an informed decision about working with you as their counselor.

For pdfFiller’s FAQs

What is courtneys counselor disclosure statement?

Courtney's counselor disclosure statement is a document that discloses any potential conflicts of interest or financial relationships that a counselor may have.

Who is required to file courtneys counselor disclosure statement?

All counselors working with Courtney are required to file the counselor disclosure statement.

How to fill out courtneys counselor disclosure statement?

The counselor must provide information about any financial relationships or conflicts of interest in the disclosure statement.

What is the purpose of courtneys counselor disclosure statement?

The purpose of the disclosure statement is to maintain transparency and ensure that clients are aware of any potential conflicts of interest.

What information must be reported on courtneys counselor disclosure statement?

The counselor must report any financial relationships, gifts, or other potential conflicts of interest.

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