INFORMED CONSENT FOR TREATMENT
Service Offered
WCAP Counseling offers the following services:
- Psychotherapy/counseling by licensed counselors and social workers
- Substance abuse specific assessments/treatment by Certified Chemical Dependency Counselor’s, licensed counselors and social workers
- Group psychotherapy programs by licensed counselors and social workers
Counseling/therapy is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals. Our practitioners utilize the professional application of evidence- based clinical interventions and techniques to provide appropriate behavioral health services to clients.
- I have voluntarily requested the professional behavioral health services of Whitehall CAP Inc., WCAP Counseling.
- I understand that this consent is for the duration of the services to be provided.
- I give my consent for a diagnostic assessment. I understand that an assessment will include doing some paperwork during the first two sessions with my therapist.
- I also consent for treatment as will be outlined in my treatment plan that I will develop with my therapist within the first two sessions.
- I understand that treatment will involve talking about my personal thoughts, feelings, and life experiences.
- I understand that therapy may cause additional stress or emotional difficulty during the course of learning how to resolve and address presenting problems.
- I understand that if a crisis occurs as it relates to my mental health treatment, that I can contact Netcare Access at 614-276-2273, call 911 or go to my nearest emergency room for assistance.
- If necessary, I understand that my therapist may ask to refer me to external medical services if they feel it is necessary to meet my therapeutic needs. Such referrals may include psychological testing, medical or psychiatric assessment and will require my signature on a release of information before my therapist can release records or make a referral.
- If court ordered, for treatment compliance, I understand that I may be asked to sign an Authorization for the Release of Information (ROI) for my probation officer, parole officer, children services and/or other government officials requesting documentation of my treatment participation and progress. I understand that Whitehall CAP Inc., WCAP Counseling is not responsible for any incurred problems that may result if I am not compliant with recommended treatment (e.g., If I am non-compliant with treatment, I may be required to answer to judicial authorities).
- I consent to receiving treatment services provided by Whitehall CAP Inc., WCAP Counseling and understand that no guarantees have been made as to the results of treatment or procedures provided by the agency or my therapist.
- I agree to inform my therapist of all other counseling/therapeutic, medical or psychiatric care which I receive from another agency or program.