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Professional Disclosure Statement: Informed Consent Kristin Leathers, M.A., LPC (#7379) I am grateful that you have chosen me to be your counselor. This document is meant to inform you about my education
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Start by including your name, contact information, and professional title at the top of the document.
02
Provide a brief overview of your background, education, and experience in the field.
03
Include information about any licenses or certifications you hold that are relevant to your profession.
04
Clearly outline your areas of expertise and the services you offer to clients.
05
Include any disclosures about potential conflicts of interest or limitations to your services.
06
Provide information about your fees, payment policies, and any insurance coverage you accept.
07
Finally, make sure to sign and date the document to certify its accuracy and completeness.

Who needs professional disclosure statement and?

01
Anyone providing professional services in fields such as counseling, psychology, therapy, accounting, financial planning, law, and other regulated professions.
02
Professionals working in private practice or freelancing who want to establish transparency and trust with clients.
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A professional disclosure statement is a document that outlines the qualifications, services, and potential conflicts of interest of a professional to ensure transparency and inform clients of their rights.
Typically, licensed professionals such as counselors, therapists, and financial advisors are required to file a professional disclosure statement as part of regulatory compliance.
To fill out a professional disclosure statement, gather required information including qualifications, services offered, fees, and any potential conflicts of interest, then complete the form as directed by the regulatory body.
The purpose of a professional disclosure statement is to provide clients with essential information about the professional, promoting informed consent and enhancing trust in the professional-client relationship.
Information typically reported includes the professional's credentials, business practices, areas of specialization, fee structure, and any relevant ethical considerations.
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