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Professional Disclosure Statement Linda Darlene Makers, MA, LPC, CCTP Office: (828) 8504508 Fax: (704) 7754855 Email: Lakers×casaatlkn.com Qualifications I currently hold a Master of Arts in Professional
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How to fill out a professional disclosure statement:

01
Start by gathering all the necessary information. This includes your full name, contact information, and any professional licenses or certifications you hold.
02
Next, provide a brief overview of your professional background and experience. Include any relevant education, training, and work history that is applicable to your field.
03
Be sure to disclose any conflicts of interest or potential biases that could impact your ability to provide impartial services. This may include financial interests, personal relationships, or other affiliations that could pose a conflict.
04
Additionally, include a section on your scope of practice and the services you offer. Clearly outline the types of clients or populations you specialize in, as well as any limitations or restrictions to your services.
05
It is also important to include information about your fees and billing practices. Describe how you charge for your services, whether it is an hourly rate, per session, or on a retainer basis. Be transparent about any additional costs or fees that may apply.
06
Lastly, include any other relevant information or disclosures specific to your profession or industry. This could include professional codes of ethics that you adhere to, confidentiality practices, or any legal obligations you must comply with.

Who needs a professional disclosure statement?

01
Professionals in fields such as mental health, counseling, therapy, coaching, legal services, and financial advising often need a professional disclosure statement.
02
Any professional who provides services or advice to clients and has an ongoing professional relationship should consider having a disclosure statement.
03
Depending on the industry and regulatory requirements, certain professionals may be legally obligated to have a professional disclosure statement. It is important to research and comply with any applicable laws and regulations in your field.
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Professional disclosure statement is a document that outlines important information about a professional's background, qualifications, and potential conflicts of interest.
Professionals such as doctors, lawyers, financial advisors, and consultants are often required to file professional disclosure statements.
To fill out a professional disclosure statement, you must provide accurate and detailed information about your education, work experience, credentials, and any potential conflicts of interest.
The purpose of a professional disclosure statement is to provide transparency and build trust between professionals and their clients, by disclosing relevant information.
Information such as education, certifications, work experience, affiliations, and any existing or potential conflicts of interest must be reported on a professional disclosure statement.
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