Get the free Professional Disclosure Statement

This document provides important information regarding the counseling process and relationship, outlining the therapist's approach, qualifications, fee agreements, confidentiality policies, and client

How to fill out professional disclosure statement

How to fill out Professional Disclosure Statement

1. Begin with your name and contact information at the top of the document.
2. Include your professional qualifications, such as degrees, certifications, and licenses.
3. Describe your areas of expertise and the services you provide.
4. Outline your fees and payment policies.
5. Provide information about confidentiality and its limits.
6. State your cancellation policy and any related fees.
7. Include information on supervision and how clients can access additional support or resources.
8. Sign and date the document at the bottom.

Who needs Professional Disclosure Statement?

1. Mental health professionals, including therapists and counselors.
2. Doctors and healthcare providers who engage in patient care.
3. Social workers and case managers.
4. Coaches and consultants in various fields.
5. Any professional providing services that require a clear understanding of their role and responsibilities.

People Also Ask about

What do you write in a disclosure statement?

A disclosure statement is a document that a landlord must give the tenant when entering into or renewing a lease. It outlines essential lease information so the tenant can understand, at a glance, the key elements of the lease. It can include: the term or duration of the lease.

What is a professional disclosure statement Oregon LPC?

The professional disclosure statement (PDS) is a document that an LPC, LMFT, registered associate, or temporary practitioner provides to each client that provides information about the practitioner and their practice. You must update your PDS if there are changes and ensure it contains current, accurate information.

Which of the following should be included in a professional disclosure statement?

The Standard Contents of a Professional Disclosure Statement Your name, contact information and professional registration status. Professional associations that you belong to. Your qualifications, including education, training and experience. Your practice philosophy.

How many hours are needed for lpc in Oregon?

Supervision Hours “Supervision” is shorthand for directed, post-graduate experience in professional counseling under supervision open_in_new in a work setting. Oregon requires aspiring LPCs to complete 2,400 hours of supervision, with at least 50 percent dedicated to direct client contact.

What is an example of a professional disclosure?

I will keep confidential anything that you say to me, with the following exceptions: a) you direct me to tell someone else, b) I determine that you are a danger to yourself or others, c) I am ordered by a court to disclose information, d) I suspect or am made aware of physical/sexual abuse of minors, persons with

What is a professional disclosure statement in counseling?

Professional disclosure statements disclose to clients the nature and boundaries of the counseling relationship they are about to enter. The written statement indicating that the client has been fully informed about the counseling relationship is signed by both the client and the counselor. "

Which of the following should be included in a professional disclosure statement?

The Standard Contents of a Professional Disclosure Statement Your name, contact information and professional registration status. Professional associations that you belong to. Your qualifications, including education, training and experience. Your practice philosophy.

What is an example of a disclosure statement?

A disclosure statement in such a case might read: “The author declares that (s)he has no relevant or material financial interests that relate to the research described in this paper”.

For pdfFiller’s FAQs

What is Professional Disclosure Statement?

A Professional Disclosure Statement is a document that outlines the qualifications, practices, and responsibilities of a professional, typically in fields such as therapy, counseling, or social work. It informs clients about the professional's background and how their services will be delivered.

Who is required to file Professional Disclosure Statement?

Professionals in regulated fields, such as therapists, counselors, and social workers, are typically required to file a Professional Disclosure Statement. This may also apply to any professional who interacts with clients or patients in a formal capacity.

How to fill out Professional Disclosure Statement?

To fill out a Professional Disclosure Statement, the professional must provide accurate information about their qualifications, including education, licensure, areas of expertise, service fees, confidentiality policies, and ethical practices. It is important to ensure that the information is clear, concise, and complies with relevant regulations.

What is the purpose of Professional Disclosure Statement?

The purpose of a Professional Disclosure Statement is to establish transparency between the professional and the client, ensuring that clients are informed about who they are working with, what to expect, and their rights within the professional relationship.

What information must be reported on Professional Disclosure Statement?

The information that must be reported on a Professional Disclosure Statement typically includes the professional's educational background, licensure status, areas of specialization, fees, policies related to confidentiality and client rights, and any potential conflicts of interest.