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  • Professional Disclosure Informed Consent Form

  • Unlockinghearts, LLC

    My name is Elizabeth Bowman. I am the founder and principle operator of Unlockinghearts, LLC. I have had the privilege to mentor, disciple, biblically counsel and journey alongside many women from a wide range of backgrounds, including those who have suffered through abortion, substance abuse, and various other forms of physical and emotional trauma. I come along side individuals to help them identify and live out the truth of their identity in Christ Jesus. I offer discipleship counseling which is gospel centered, coming alongside you as an individual with words of truth to encourage, teach, comfort and assist you during your time of need. The primarily focus is to deliver both grace and truth to help you build a solid foundation of understanding, receiving and living out your identity in Christ. Through prayer and the Word of God, I will help you come to a greater understanding of your identtity in Jesus.  The hope is that even if your circumstances do not change-you are transformed and can begin to experience Jesus in the midst of your everyday struggles in life.  Please undersatnd that I am not a licensed professional counselor. Elizabeth is commissioned as a Minister by Network 220.

     ( www.network220.org) a network of ministers that biblical counsel with explicit goal of helping people live an abundant life in Christ.

    Romans 12:2 "Do not be conformed to this world, but be transformed by the renewal of your mind, that by testing you may discern what is the will of God, what is acceptable and perfect."

     

    CLIENT AGREEMENT

    Thank you for your interest in working with me as a client. Please read this information carefully and ask any questions you may have before signing this agreement.

    Phone calls:( 803-760-7808)  Calls are returned Monday through Friday, all calls will be returned within 1 business day. Please leave your phone number and first name with your message.


    Emergencies: If you have an emergency please call 911 or go to your nearest Hospital Emergency Room. If you feel I need to be made aware of the situation please call me after seeking appropriate emergency care.

    Cancellation policy: Unlockinghearts has a 24 hour cancellation policy. If you fail to cancel a scheduled appointment, I cannot use this time for another client. Please be aware any outstanding cancellation fees must be paid before scheduling another appointment.

    Therefore, you will be billed for the entire cost of a missed appointment.

    Education and Professional Memberships

    -B.A. Psychology, University of North Carolina at Chapel Hill

    -Advanced Discipleship Training At Grace Life International

    -Board certification as a Biblical Counselor, Light University and IBCC ( International board of Christian Care)

    -Certified Addcition and Recovery Specialist, Light University and IBCC ( International board of Christian Care)

    -Internal Family Systems Level 1 curriculum.

    -Level 1 Inner Healing Prayer, Christian Healing Ministries

    -AACC Member, American Association of Christian Counselors

    -CFSAS-C-SASI Group Facilitator Sex Addiction Specialist

     

     

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    Outcome Expectations/Risk & Benefits/ Plan

    Please note that it is impossible to guarantee any specific results regarding your goals. However, we will work together to achieve the best possible results for you. Our work together requires your very active involvement, honesty, and openness in order to change your thoughts, feelings and/or behavior. You will have to work both in and out of our sessions. I will ask for your feedback and views on our work and its progress and will expect you to respond openly and honestly. As with any discipling there are risks

    Risks might include remembering, talking about, or experiencing unpleasant events which results in uncomfortable levels of feelings like sadness, guilt, anxiety, anger, frustration, worry, etc., or experiencing anxiety, depression or insomnia, etc., or having difficulties with other people. Being confronted with your difficulties can be very challenging. Some changes may lead to what seems to be worsening circumstances or even losses. Please be advised that emotional or physical sensations or additional unresolved memories may surface which could be perceived as negative side effects. You may experience some temporary emotional distress and physical discomfort related to prior life experiences.

    If we are to work together we will need to specify methods, risks and benefits of treatments, the approximate time commitment involved, costs and other aspects of your particular situation. We will discuss a plan that seems most appropriate to help you reach your goals. However, regardless of our work together, you agree to take full responsibility for your self-care in the emotional, mental, physical, and spiritual dimensions of your life.

     

    THE NATURE OF Unlockinghearts, LLC CLIENT RELATIONSHIP:

     

    The client understands that the Unlockinghearts, LLC relationship is not psy­chotherapy, psychological counseling, or any type of therapy; nor is it a substitute for these services. In the event the client recognizes the need for professional counseling or ther­apy, it is the responsibility of the client to seek a licensed professional who can provide these services. If at any time I, Elizabeth Bowman, founder of Unlockinghearts, LLC can refer the client out, should I recognize  that the scope of work is out of my training and level of expertise.  Unlockinghearts, LLC believes that such services will be valuable to the client and will recommend them. Unlockinghearts, LLC personnel may provide suggestions for change to the client, but the client is always seen as a person accountable for his/her own decisions.

    Please be advised that I am not a licensed mental health professional and the approaches I offer are not intended to be a substitute for medical diagnosis or psychotherapy and they do not replace the services of a licensed physician or licensed psychotherapist. You agree and understand it is your responsibility to consult with your physician/psychiatrist for any specific medical problems. Further, you understand I may suggest you contact your physician or psychologist/psychiatrist if I believe it’s advisable. In addition, you understand that any information shared during our sessions is not to be considered a recommendation that you stop seeing your physician or using prescribed medication, if any, without consulting with your physician/psychologist, even if after a session it appears and indicates that such medication or treatment is unnecessary

    CONFIDENTIALITY

    The information that you share with me during our sessions will be kept confidential. The privacy of our conversations and the records of our time together are a privilege of yours and are protected by state law and ethical standards. There are some circumstances in which I cannot guarantee confidentiality:

    ·      If the Unlockinghearts, LLC personnel feels you are about to do harm to you, to someone else, or to property, they must, by law, take steps to protect the vulnerable party. Any suspected abuse of a minor, the elderly, or the handicapped must also be reported.

    ·      If the Unlockinghearts, LLC personnel feels it would be in your best interest to consult with counseling colleagues, they reserve this right, while protecting your identity.

    ·      When a court orders a release of information

    ·      Client has the right to request their records at anytime.

     

    LENGTH OF SESSIONS AND PAYMENT

     

    The length of the sessions will be 50 minutes. Payment of $75.00 (cash, check or credit) is expected at the beginning of each session.  If client chooses to go over the allotted time; if it is available, the cost will be additional billing in incredments of 15 minutes, which would be 25 dollars. If you need to cancel an appointment, please do so 24 hours in advance or as soon as possible. If I do not receive notice, you will be charged for the session. Unfortunately, I cannot bill your insurance company.

     

     

  • Acknowledgement

    I have reviewed this Informed Consent Agreement. I likewise understand my Client's Rights set in this form.

    I accept this agreement and consent to counseling.

    By signing this Client Information and Confidentiality, Disclosure, and Consent Form, I acknowledge that I have read, understand, and agree to the terms and conditions contained in this form. I have been given appropriate opportunity to address any questions or request clarification for anything that is unclear to me. I am voluntarily agreeing to receive services for me, and I understand that I may stop such services at any time.

    Except in the case of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless Elizabeth Bowman and Unlockinghearts, LLC from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s).

     

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  • DOCTRINAL STATEMENT

     

    We believe that the Bible, God’s Word, teaches:

     

    1.   The Verbal inspiration of the Bible

     

          We believe the Holy Scriptures, both the Old and New Testaments, to be verbally inspired of God in the original manuscripts; infallible, inerrant and God-breathed, a perfect rule of faith and practice. 2 Timothy 3:16, 2 Peter 1:20,21 1 Corinthians 2:12-13

     

    2.   The Trinity

     

          We believe in one God, eternally existing in three Persons: Father, Son and Holy Spirit. Matthew 3:16-17, Mark 1: 10-11, Luke 3:21-22

     

    3.   The Lord Jesus Christ

     

          We believe that God, the Son, who has always existed, became a man (without diminishing His deity) by virgin birth through Mary. He lived a sinless life and as the infinite God-Man took upon Himself the sins of all men, died in their place and satisfied God concerning their sins. We further believe in the literal, physical resurrection of Jesus Christ from the dead. He was then ascended and exalted to the right hand of God as the Great High Priest of all believers. John 1:1, Colossians 1:15-17, Romans 5:8, 1 John 2:2, 1 Corinthians 15:1-8, Ephesians 1:20, Hebrews 2:17

         

    4.    The Holy Spirit

     

          We believe that the Holy Spirit is a Divine Person, who convicts the world of sin, of righteousness and of judgment. He is the Supernatural Agent in regeneration, sealing them unto the day of redemption and leads believers into all truth. Genesis 2:2, John 16:18, John 14:26, John 3:6, Ephesians 1:13

     

    5.    Man

         

          We believe that man was created in the image and likeness of God, but, that in Adam’s sins, the race fell and became alienated from God; and, that man is totally depraved in his adamic spiritual identity and, of himself, is utterly unable to remedy his lost condition. Genesis 1:27, Genesis 3:1-6, Romans 5:12, Romans 3:23

     

    6.   Salvation

     

          We believe that salvation is the gift of God brought to man by grace and received only by personal faith in the Lord Jesus Christ (apart from any works by man) whose precious blood was shed on Calvary for the forgiveness of sins.  Upon receiving salvation, the person receives eternal life, becomes a partaker of Christ’s life and is saved. He becomes a new creation and now has a new identity as a child of God. Ephesians 2:8-9, Ephesians 1:7, 1 John 5:12-13, 2 Corinthians 5:17, Romans 8:16

                     

    7.    Eternal Security

     

          We believe that all who are in Christ will never lose this relationship. John 10: 27-29, Romans 8:35-39, Philippians 1:6      

                     

    8.    Satan and Demons

     

          We believe that Satan is a fallen angel who is aided by a host of evil spirit beings called demons. Their design is to destroy believers, their homes and their churches, and to blind the lost to the gospel. Every believer is subject to their attack but may be made victorious through Jesus Christ. Isaiah 14:12, Matthew 8:16, Ephesians 6:10-18, 2 Corinthians 4:4

         

    9.    Sanctification

     

          Each believer partaking of eternal life (Christ’s life) was united with Christ, thus crucified, buried, raised and enthroned with Christ. The old man died at that point in time. The results of co-crucifixion must become an experiential reality to each believer as he chooses to walk in the Spirit and not after the flesh if he is to walk in victory. Sanctification, then, is Christ living His life out through the believer to love God and people. This is not teaching passivity, sinless perfection or the deification of man. As the believer trusts Christ to live through him/her, he/she will be able to consistently, not perfectly, line up his/her lifestyle with God’s Word. Romans 6:1-6, 1 John 5:12-13, Romans 8:1-8, Galatians 2:20

     

    10.  Marriage and Sexuality

     

         We believe that God has established marriage as an exclusive relationship between one man and one woman. We believe that God created the human race male and female. We believe that all conduct with the intent to adopt a gender other than one’s birth gender and all intimate sexual activity outside the marriage relationship, whether heterosexual, homosexual, or otherwise, is sin.

    Gen. 2:24-25; Ex. 20:14, 17, 22:19; Lev. 18:22-23, 20:13, 15-16; Matt. 19:4-6, 9; Rom. 1:18-31; I Cor. 6:9-10, 15-20; I Tim. 1:8-11; Jude 7. Gen. 1:27; Deut. 22:5

     

    *This Doctrinal Statement is based on Scripture from the New American Standard Bible.

     

     

     

    By my signature, I affirm that I understand that the Bible, including the Doctrinal Statement of Unlockinghearts, LLC, will be the basis for all discipleship counseling or mentoring,through Unlockinghearts,LLC

     

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