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Consent to Release Information SUSAN ROSS, MSW, LIST ADDING SOLUTIONS 1400 112th Avenue SW, Bellevue, WA 98040 2068619577 www.susanross.com Client Name: DOB: Parent/Guardian (if applicable): Information

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How to fill out counselor-client services agreement

01

Step 1: Begin by entering the date on the top left corner of the agreement.

02

Step 2: Enter the name and contact information of the counselor and the client.

03

Step 3: Specify the scope of the counseling services that will be provided.

04

Step 4: Outline the duration and frequency of the counseling sessions.

05

Step 5: Include details about the payment terms and any cancellation policies.

06

Step 6: Include any confidentiality clauses and the limitations of confidentiality.

07

Step 7: Specify any additional terms and conditions that both parties need to agree upon.

08

Step 8: Leave space for signatures and date at the bottom of the agreement.

09

Step 9: Review the agreement with both parties before signing to ensure understanding and agreement.

10

Step 10: Keep a copy of the signed agreement for future reference.

Who needs counselor-client services agreement?

01

Counselors or therapists who provide professional counseling services to clients.

02

Clients who engage the services of a counselor or therapist for their mental health or personal development needs.

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What is counselor-client services agreement?

The counselor-client services agreement is a formal document that outlines the terms and conditions of the relationship between a counselor and their client, detailing the services provided, responsibilities, and expectations.

Who is required to file counselor-client services agreement?

Counselors who provide services to clients as part of their professional practice are required to file the counselor-client services agreement.

How to fill out counselor-client services agreement?

To fill out the counselor-client services agreement, a counselor must complete sections detailing client information, the scope of services, confidentiality clauses, and signatures from both parties.

What is the purpose of counselor-client services agreement?

The purpose of the counselor-client services agreement is to establish clear boundaries, set expectations for treatment, and protect the rights of both the counselor and the client.

What information must be reported on counselor-client services agreement?

The information that must be reported includes client details, counselor credentials, description of services, confidentiality terms, and the method of communication between the counselor and client.

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