Get the free Professional Disclosure Statement

This document provides important information about the professional practices and policies of Denise Hockley Counseling, including therapy philosophy, fees, confidentiality, and client rights.

How to fill out professional disclosure statement

How to fill out professional disclosure statement

1. Begin by including your name, title, and credentials at the top of the document.
2. Provide your contact information, including a phone number and email address.
3. Clearly state the purpose of the professional disclosure statement.
4. Outline your qualifications, including education, training, and certifications relevant to your practice.
5. Describe your areas of expertise and the services you offer.
6. Include any relevant fees or payment policies associated with your services.
7. Explain your approach to confidentiality and privacy practices.
8. Provide information about the limits of confidentiality, such as mandatory reporting laws.
9. State your policies on cancellations and rescheduling appointments.
10. Include a statement indicating that clients have the right to ask questions and express their concerns.
11. Conclude with a section for the client to acknowledge receipt of the statement, including a signature line and date.

Who needs professional disclosure statement?

1. Anyone providing professional services to clients, including therapists, counselors, coaches, and social workers.
2. Organizations that operate in fields requiring client interaction and confidentiality.
3. Practitioners who seek to establish transparency and trust with their clients.

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What is professional disclosure statement?

A professional disclosure statement is a written document that outlines a professional's qualifications, experience, and the nature of the services they provide. It aims to inform clients about the professional's credentials and ethical responsibilities.

Who is required to file professional disclosure statement?

Professionals such as therapists, counselors, medical practitioners, and other licensed service providers are typically required to file a professional disclosure statement as part of their ethical and legal obligations.

How to fill out professional disclosure statement?

To fill out a professional disclosure statement, professionals should gather their qualifications, licenses, areas of expertise, fee structures, and policies around confidentiality and conflicts of interest. This information should be clearly and accurately presented in the designated format or template.

What is the purpose of professional disclosure statement?

The purpose of a professional disclosure statement is to promote transparency between the professional and the client, ensuring that clients are fully informed about the professional's qualifications and the nature of the services offered.

What information must be reported on professional disclosure statement?

A professional disclosure statement must report information such as the professional's qualifications, licenses, scope of practice, fees, cancellation policies, confidentiality policies, and any other relevant information that may impact the client’s decision to engage in services.