Get the free Professional Disclosure Statement

This document serves as a professional disclosure statement outlining Katherine L. OReilly\'s qualifications, services offered, payment processes, and client agreement for therapy sessions. It details her educational background, clinical experience, therapeutic methods utilized, and the fees associated with her counseling services.

How to fill out professional disclosure statement

How to fill out professional disclosure statement

1. Begin with personal information: Include your name, professional title, and contact information.
2. State your qualifications: List your educational background, certifications, and relevant experience.
3. Define the scope of your practice: Clearly explain the services you offer and any limitations.
4. Discuss confidentiality: Outline how you will protect the client's information and confidentiality.
5. Explain fees and payment policies: Provide details on your fees, payment methods, and any cancellation policies.
6. Mention any potential conflicts of interest: Disclose any personal or professional relationships that could affect your work.
7. Provide information about supervision or consultation: If applicable, explain any supervision practices you follow.
8. Include a signature line: Provide a space for both you and the client to sign and date the statement.

Who needs professional disclosure statement?

1. Mental health professionals: Therapists and counselors must provide their clients with a professional disclosure statement.
2. Medical practitioners: Doctors and other medical personnel often need to disclose their qualifications and practices.
3. Legal professionals: Lawyers may need to share their professional information with clients.
4. Any service providers: Individuals offering professional services that involve client interaction should have a disclosure statement.

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What is professional disclosure statement?

A professional disclosure statement is a document that outlines a professional's qualifications, services offered, and any potential conflicts of interest, intended to inform clients or patients about the professional's background and practices.

Who is required to file professional disclosure statement?

Professionals such as therapists, counselors, and other licensed practitioners are typically required to file a professional disclosure statement to ensure transparency with their clients.

How to fill out professional disclosure statement?

To fill out a professional disclosure statement, one should include their educational background, professional experience, services provided, fee structure, confidentiality policies, and any potential conflicts of interest.

What is the purpose of professional disclosure statement?

The purpose of a professional disclosure statement is to promote transparency and trust between professionals and their clients by providing comprehensive information about the professional's qualifications and practices.

What information must be reported on professional disclosure statement?

Information that must be reported includes the professional's qualifications, relevant experience, services offered, fee information, confidentiality practices, and any potential conflicts of interest.