Counselor disclosure statement free printable template

Counselor Disclosure Statement Naomi Long, MS MHC License #LH00008429 2013 W. 4th Ave #2, Spokane, WA 99201, 509.280.6195 Counselors are required by Washington state law (RCW 18,225,100) to provide

How to fill out clients confidential form

How to fill out Counselor disclosure statement

1. Start with your full name and contact information at the top of the document.
2. State your professional qualifications, including degrees, certifications, and licenses.
3. Describe your counseling approach and any specific techniques you use.
4. Explain your confidentiality policies, detailing what is kept private and any legal exceptions.
5. Outline the limits of your services, including any conditions that you do not address.
6. Include potential risks and benefits of counseling.
7. Provide information about fees, payment methods, and cancellation policies.
8. Mention whether you have supervision or consultation processes in place.
9. Conclude with a section for the client to ask questions or express concerns.

Who needs Counselor disclosure statement?

1. The Counselor Disclosure Statement is needed by clients seeking counseling services to understand the counselor's qualifications and policies.
2. It is also necessary for any counseling professional who is required to maintain transparency and ethical practices in their work.

People Also Ask about counselor provide consent

What is the confidentiality statement for counseling?

Counselling is confidential. This means I will not share information about you with a third party unless you consent to that disclosure. So I will not tell anyone that you attend counselling, or what you say in our sessions, without your permission to do so.

Which is the best example of self-disclosure?

However, revealing, “I am an avid surfer” or “My favorite kind of music is “electronic trance” would be examples of self-disclosure because these are pieces of personal information others do not know unless you tell them.

What are some examples of self-disclosure?

We self-disclose verbally, for example, when we tell others about our thoughts, feelings, preferences, ambitions, hopes, and fears. And we disclose nonverbally through our body language, clothes, tattoos, jewelry, and any other clues we might give about our personalities and lives.

What is a professional disclosure statement in counseling?

The professional disclosure statement (PDS) is a document that an LPC, LMFT, or registered associate gives to each client that provides information about the licensee/registered associate and their practice. Who must have a PDS? Every applicant for licensure must submit a PDS as part of his or her application.

What are the 4 types of self-disclosure?

There are four different types of self-disclosures: deliberate, unavoidable, accidental and client initiated.

What is an example of a self-disclosure statement?

I deeply regret what I did but some good has come out of it. I've seen the impact that my conviction has had on my family and I know that I am now better able to deal with any situation I find myself in, in a much more constructive and calm way.

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What is Counselor disclosure statement?

A Counselor disclosure statement is a document that outlines the qualifications, services, fees, and ethical considerations of a counselor. It aims to inform clients about the counseling process and the counselor's professional background.

Who is required to file Counselor disclosure statement?

Counselors and therapists who provide mental health services to clients, especially in a licensed setting, are typically required to file a Counselor disclosure statement. This includes licensed professional counselors, marriage and family therapists, and social workers.

How to fill out Counselor disclosure statement?

To fill out a Counselor disclosure statement, first gather all necessary information including your educational background, credentials, areas of expertise, services offered, fees, and any relevant ethical guidelines. Then, complete the form by clearly presenting this information in a structured manner, ensuring to adhere to any specific regulatory requirements.

What is the purpose of Counselor disclosure statement?

The purpose of a Counselor disclosure statement is to provide transparency to clients regarding the counselor's qualifications and the nature of the services offered, helping clients make informed decisions about their mental health care.

What information must be reported on Counselor disclosure statement?

The information that must be reported on a Counselor disclosure statement typically includes the counselor's name, credentials, license number, areas of specialization, a description of services offered, fees, cancellation policies, and ethical standards applicable to their practice.