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Informed Consent

As part of the ethical requirements of a licensed clinical mental health provider, a full detail of experience and credentials must be presented prior to beginning any services.  This information provides you with disclosure of services and clinical orientation. 

2024 Provider Information

CONSENT FOR TREATMENT

This information is designed to give you a better understanding of my background, qualifications, and experience as a professional counselor. It will also provide you with a clear understanding of the professional relationship between the counselor and client and an outline of what to expect during treatment. Please take the time to familiarize yourself with this information. In accordance with ethical guidelines, you are asked to give your informed consent to participate. 

EDUCATIONAL BACKGROUND AND TRAINING

I hold a Master’s degree in counseling from Gordon-Conwell Theological Seminary graduating in 2008. I am board certified as a LCMHC(License No. 7906) or Licensed Clinical Mental Health Counselor under the requirements specified by the North Carolina Board of Licensed Professional Counselors as of 6/11/10. I am concurrently registered with the North Carolina Substance Abuse Professional Practice Board (NCSAPPB) and a Licensed Clinical Addiction Specialist, LCAS (license no 1681) as of 9/16/10. My private practice is geared towards helping individuals, couples and families overcome barriers in communication as well as addiction, anxiety, grief, mood disorders and other emotional traumas. I am in the South Park area of Charlotte, NC. 

 

WHAT TO EXPECT IN TREATMENT

Your participation in treatment is entirely voluntary and will be based on your personal needs and goals. While you may experience heightened emotions during treatment, the risk of adverse effects is low. It is expected that you will experience benefit from participating in therapy in a way that increases personal awareness and growth. It is important to remember you are in a professional rather than a social relationship. If you are sick, unable to attend, or if you are going to be late, please call 24 hours prior to your appointment. Please make every effort to arrive on time. Failure to inform will be considered as contracted time and will be invoiced to you regardless of your attendance. I will be using well-established and clinically proven approaches in therapy that are best suited to bring about desired positive change.

 

WHAT YOU NEED TO KNOW ABOUT CONFIDENTIALITY

The information you provide is treated with the utmost respect and is protected by law and by professional ethical guidelines in all but a few instances without your consent. Those instances include when it is believed that you intend to harm yourself or others, when it is believed a child or elder person will be or is being abused or neglected, or when the court system requires information and meets legal requirements for disclosure which would include a direct court order from a judge which is different from a subpoena. In these rare circumstances, confidentiality cannot be guaranteed. Should the situation arise to report any anticipated harm to self or others please note that we will handle the situation together. However, I will not knowingly violate any state or federal law or regulation.      

 

Violation of the Federal Law and Regulations is a crime. This would include any violation to your privacy or failure to inform others of potentially harmful action. Suspected violations may be reported to appropriate authorities in accordance with Federal Regulations. (See 42 USC 290dd.3 and USC 290ee.3 for Federal Laws and 42 CFR Part 2 for Federal Regulations.) Should we have a need to bring in other specialists during treatment, we will discuss these options and review the parameters of a separate Release of Information in which you are fully informed for release of information. If you have any additional questions about your legal rights in this matter, please bring up your concerns at any time during treatment. Should for any reason, I am unable to provide service, we will discuss your preferences for continuation of care from another service provider. You may have questions that have not been answered in this overview. Please feel welcome to discuss any aspect of treatment you do not understand.

 

Many of my patients request contact outside of sessions via telephone, text or email. I am available for contact, but you must consent in writing prior to the onset of communication. I cannot control who might have access to your email or text and your privacy regarding therapy is your responsibility. My time for phone and email responses are additional to the cost of services provided during an on-premise visit. We will discuss the mode of communication best suited to our agreed upon clinical goals. 

 

HOW TO GET THE MOST OUT OF TREATMENT  

I utilize an integrated theoretical model for treatment that includes but is not limited to motivational, cognitive-behavioral, solution-focused, and behavioral therapy. I also integrate spirituality into the therapeutic setting utilizing a 12-step model for change regarding any condition or circumstance. I work best with individuals who actively seek positive psychological development but may be experiencing a life event, condition, or circumstance that is preventing them from moving forward in emotional stability. This may include substance abuse, chemical dependency, mood disorders, dual diagnosis, OCD, or life event issues such as job loss, career decisions, job change, life-cycle changes such as separation or divorce, illness, or death. These are considered temporary adjustment issues and counseling may help to alleviate the negative emotions associated with unexpected or unwanted change. In cases where indicated and with your consent, I will work with a physician or others to coordinate optimum care. 

                                                                                                        

COMPLAINTS   

Although you are encouraged to discuss any concerns with me directly, you may also file a complaint with my professional board should you feel there is evidence of an ethical violation outlined by the ACA Code of Ethics. You may review these codes at www.counseling.org under the Code of Ethics category. You may contact this board at anytime at the North Carolina Board of Licensed Clinical Mental Health Counselors, PO Box 77819, Greensboro, NC 27417 or by phone at 844-622-3572, or by email at LCMHCinfo@ncblcmhc or by fax 336-217-9450.

 

PAYMENT                                                                                

Payment may be made prior to each session of treatment. Average sessions will last at a minimum of 50 minutes. I am an out of network provider. You may file for an insurance reimbursement if you have out-of-network benefits. Be advised that they may require detailed information regarding diagnosis, progress and treatment plan which ultimately becomes part of your permanent medical records. All communications outside of our sessions are considered additional to the cost of services and invoiced to you based on an hourly rate. 

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