All therapists at The Peacemaker Center are experienced and professionally trained. I/we understand the relationship established with our therapists is voluntary and I/we have the right to end the relationship at any time. All client information and client records are strictly confidential. Information is shared only with authorized professional staff, including clinical supervisors, and the persons I/we have listed below. The only exceptions to this policy are as follow: 

• If our staff has reason to believe that a child has been physically or sexually abused, we are required by law to report it to the state protection service. We are not making a determination that any behavior is unlawful or improper. That determination is made by the state.
• If our staff has reason to believe that a client may seriously harm him/herself or another person, we are required to release information to protect the person who may be harmed.
• Selected records may be made available to certifying or licensing organization for review of our record-keeping procedures.
• If information is shared during an individual counseling session that will impact the couples’ therapy or relationship, the therapist may share that information with the spouse/partner. Either spouse/partner may choose to end couple’s therapy and begin individual therapy, at which point, information shared would be confidential, even from the spouse/partner.

Litigation Limitation

As a participant in therapy at The Peacemaker Center I/we understand and agree that no employee, agent, or principal of The Peacemaker Center shall be called as a witness to testify on our behalf, or on behalf of our children in any legal proceedings concerning my/our therapy. Further, I/we understand and agree for myself/ourselves, and for those who would represent us, that no documentation, other than recommendations, prepared in conjunction with The Peacemaker Center shall be subject to subpoena or records deposition for use in legal proceedings. I/we understand that this provision is necessary in order to foster frank, open, and meaningful exchanges between myself/ourselves and my/our therapist. I/We understand that I am/we are giving up our right to use testimony, records, or other information contained at The Peacemaker Center, but that I/we do so voluntarily, and without undue influence, for the purpose of establishing confidentiality and privilege for myself and The Peacemaker Center, which right and privilege shall not hereafter be revoked by me or my legal representative. I/We understand that the only communication between The Peacemaker Center and/or Court will be limited to a form letter stating when the services were begun and/or whether the client completed, did not complete, or are still undergoing therapy. 

Payment Policies / Fee Schedule

I/We accept financial responsibility for all charges incurred during services provided by The Peacemaker Center, including bank fees for returned checks. I/We understand the payment policies for private sessions and that full pay is $165 per 50-minute session. Since the therapist’s time has been reserved, full payment of determined fee is expected for no shows and cancellations with less than 24-hour notice. I/We understand that for my sessions my therapist will determine my fee.

Telehealth Therapy Sessions

• The Peacemaker Center will do its best to ensure confidentiality and security, however with technology, confidentiality and security cannot always be guaranteed for telehealth therapy sessions. 
• I/we acknowledge that remote therapy, using cell phones, email, video conferencing, etc. may have security risks.
• The client is responsible for securing their own computer, internet access points, and password security.
• The Peacemaker Center is not liable for confidentiality breaches that are in direct response to the client's actions.
• The Peacemaker Center is not responsible for client equipment failure, e.g. camera, and/or internet service.
• The client is not permitted to make an audio or video recording of any portion of the telehealth session. 
• I/we understand that it is the client's responsibility to bring to the therapists attention any difficulties they are having as a result of telehealth therapy sessions, including any difficulties that may not be apparent to the therapist because of telehealth sessions.

Client

In the treatment of a couple or a family, The Peacemaker Center will seek the authorization of all member of the treatment unit before the release of confidential information to third parties. I/We understand in order to protect confidentiality, any inquiries other than the below-mentioned exception (written, telephone or personal) will not be answered until I/we sign a separate Authorization for Release of Information.