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Informed Consent Form
For Family Counseling
Diana Bermúdez, PhD, LPC
3801 N Fairfax Dr. Suite 30, Arlington, VA 22203
Licensed Professional Counselor #0701005719
(703) 8683439, Arlington, VA 22207
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How to fill out professional counseling informed consent

How to fill out professional counseling informed consent
01
Begin by identifying the client's personal information, including their name, contact information, and any relevant identification numbers.
02
Clearly state the purpose of the counseling sessions and the goals that will be worked towards.
03
Include information about the counselor's qualifications, credentials, and any relevant experience.
04
Explain the confidentiality policy and the limits to confidentiality, including situations where the counselor may be legally obliged to disclose information.
05
Detail the client's rights and responsibilities during the counseling process.
06
Provide information on the fees, payment policies, and cancellation policies.
07
Outline the boundaries of the counselor-client relationship, including any limitations or restrictions.
08
Cover the process for obtaining client consent for any specific techniques or interventions that may be used.
09
Include information on the counselor's availability, contact methods, and emergency procedures.
10
Clearly state that the client has the right to ask questions, seek clarification, and withdraw consent at any time.
11
Ensure the client has read and understood the informed consent form by including a signature and date line.
12
Keep a copy of the signed informed consent form for both the counselor and the client's records.
Who needs professional counseling informed consent?
01
Anyone who seeks professional counseling services needs to provide informed consent. This includes individuals dealing with mental health issues, relationship problems, personal growth, career development, or any other concerns that may benefit from the support and guidance of a professional counselor.
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What is professional counseling informed consent?
Professional counseling informed consent is a legal document that outlines the details of the counseling process, including the counselor's qualifications, the goals of counseling, potential risks and benefits, and the client's rights and responsibilities.
Who is required to file professional counseling informed consent?
Both the counselor and the client are required to sign and file professional counseling informed consent before beginning counseling sessions.
How to fill out professional counseling informed consent?
Professional counseling informed consent can be filled out by providing accurate and detailed information about the counseling process, discussing any concerns or questions with the counselor, and signing the document to indicate agreement.
What is the purpose of professional counseling informed consent?
The purpose of professional counseling informed consent is to ensure that both the counselor and the client are informed about the counseling process, their rights and responsibilities, and to establish a clear understanding of the goals of counseling.
What information must be reported on professional counseling informed consent?
Professional counseling informed consent must include the counselor's qualifications, the goals of counseling, potential risks and benefits, confidentiality policies, session fees, and the client's rights and responsibilities.
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