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William R. Powell, LPC-S, Used, NCC, MHC Therapist PEACE OF MIND, INC. 817 West Front Street, Billington, NC 27546 P.O. Box 2088 Billington, NC 27546-2088 Office: (910) 814-2197 Fax: (919) 814-2167

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How to fill out lpc professional disclosure statement:

1. Begin by providing your personal information, such as your full name, contact information, and professional qualifications.
2. Include details about your educational background, including the institutions you attended, degrees earned, and any certifications or licenses you hold.
3. Outline your areas of expertise or specialization within the field of counseling or psychotherapy, highlighting any specific populations or issues you have experience working with.
4. Clearly state your counseling philosophy and approach, outlining the theoretical orientations or modalities you utilize in your practice.
5. Include information about your professional experience, including the duration of your practice, any clinical or supervisory positions held, and any professional organizations or affiliations you are a part of.
6. Address any ethical considerations, such as your commitment to client confidentiality, informed consent, and the boundaries and limitations of your practice.
7. Provide details about your fee structure, including the cost per session, any accepted insurance plans, and cancellation or payment policies.
8. Include information about your office location, hours of operation, and any accessibility accommodations available.
9. Clarify the client's rights and responsibilities, outlining what they can expect from the therapeutic relationship and what is expected of them.
10. Finally, include any additional information or disclosures that may be relevant to your practice or the therapeutic process.

Who needs lpc professional disclosure statement:

1. Licensed Professional Counselors (LPCs) who are in private practice or offering counseling services independently.
2. LPCs who are employed by counseling agencies or organizations that require their therapists to provide a professional disclosure statement.
3. LPCs who are seeking to be in compliance with their professional licensing board's requirements for ethical practice and disclosure.
4. Clients or potential clients who are considering entering into a counseling relationship with an LPC and want to have a thorough understanding of the counselor's background, qualifications, and approach before making a decision.

People Also Ask about

What is a statement of disclosure in counseling?

The written statement indicating that the client has been fully informed about the counseling relationship is signed by both the client and the counselor. " Disclosure statements are also legal contracts".

How do you write a disclosure statement for a therapist?

The following items are often included: Contact info. Your qualifications including training, experience, licensure and certifications. Professional associations that you belong to. Any limitations on your practice such as being under supervision. Services offered. Your theoretical foundation and counseling approach.

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

YOUR PROFESSIONAL DISCLOSURE STATEMENT MUST INCLUDE ALL OF THE FOLLOWING INFORMATION: Your name, business address, and telephone number. (If not currently employed provide your name, address and telephone number as shown on your application for licensure.) A description of your practice.

What is an example of a personal disclosure?

We could disclose something a bit more personal like “I'm having problems with my boyfriend.” Or we could disclose extremely personal things like “I was raped as a teenager.” Of course, the experience of sharing personal details of our lives depends crucially on how personal they are.

How do you write a professional disclosure statement?

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 an example of a disclosure statement for counseling?

I will keep confidential anything you say as part of our counseling relationship, with the following exceptions: (a) you direct me in writing to disclose information to someone else, (b) it is determined you are a danger to yourself or others (including child or elder abuse), or (c) I am ordered by a court to disclose

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What is lpc professional disclosure statement?

The LPC (Licensed Professional Counselor) Professional Disclosure Statement is a document that provides clients with essential information about the counselor's qualifications, services, and policies.

Who is required to file lpc professional disclosure statement?

Licensed Professional Counselors (LPCs) are required to provide a Professional Disclosure Statement to their clients before starting therapy or counseling services.

How to fill out lpc professional disclosure statement?

To fill out the LPC Professional Disclosure Statement, the counselor must include their credentials, areas of expertise, therapeutic approaches, fees, informed consent details, and any limits to confidentiality.

What is the purpose of lpc professional disclosure statement?

The purpose of the LPC Professional Disclosure Statement is to ensure transparency and to inform clients about the counselor's qualifications, therapy process, and any risks involved in counseling.

What information must be reported on lpc professional disclosure statement?

The LPC Professional Disclosure Statement must report information such as the counselor's license number, educational background, areas of practice, fees for services, cancellation policies, and limits of confidentiality.