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CONSENT FOR TREATMENT
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Phoenix Counseling Center utilizes a client-centered, trauma-informed approach. Our motto, “Counseling from the Heart,” describes the warm, home-like setting you will experience while in treatment at Phoenix Counseling Center.

We are a nonprofit, outpatient counseling center offering substance use and mental health services for adults, adolescents, parents, and families living in the Rogue Valley. Our treatment services include individual, group, couples, and family counseling sessions for voluntary and mandated clients.

There are potential risks associated with any form of counseling. Risks might include experiencing unpleasant and/or uncomfortable feelings. Counseling also involves the potential benefit for greater awareness of self, improved problem-solving abilities, improved communication skills, and stable recovery.

At Phoenix Counseling Center you can be assured that no information you share with your counselor or other staff member will be shared with anyone outside of agency staff, unless you have given us written consent to do so.

We also expect you to honor the confidentiality of other clients at the agency. Please do not share any information you receive from other clients with anyone else, unless that information concerns threat of harm to that client or to others, in which case the information should only be shared with a staff member who will then inform the appropriate entities. Confidentiality is important in the group setting so that you and others may feel comfortable to share what you want. Breaches of confidentiality regarding information gained from other clients/group members (including names of group members) may result in you being discharged from services at Phoenix Counseling Center.

My signature on this document indicates that I understand there may be possible risks and benefits associated with treatment.

I have chosen to participate in outpatient counseling, either voluntarily or in order to comply with mandates. I understand and agree that I will participate in services and that I may discontinue treatment and/or withdraw my consent for treatment at any time.

Your treatment may include a combination of individual and group sessions. You and your counselor will create your individual service plan, according to your specific goals and needs.
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Treatment is most successful through consistent attendance. Please attend all weekly treatment sessions.
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Check-in at the front office 10-15 minutes before your session.
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If you need to miss a scheduled appointment, please notify us 24 hours in advance.
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Counseling fees are due at the time of service, unless other arrangements have been made.
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Research has shown that clients who provide UAs as part of their drug and alcohol treatment hold themselves more accountable and are more successful. Therefore, you can expect that your counselor will ask you to provide random UAs throughout your treatment experience. If, at any time, you choose not to UA when requested, that UA will be counted as a positive.
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Abstinence from all substances is the primary goal of treatment at Phoenix Counseling Center.
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Any threats or acts of violence toward staff or other clients, or the possession/use of a weapon will invalidate your right to confidentiality and appropriate action will be taken (including contacting law enforcement).
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If you are on any prescription medications, we will ask you for a copy of them for your file.
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If a staff member suspects that you are under the influence of a substance while at PCCi: You may be asked to provide a UA -AND- We will work with you to ensure that you get a safe ride home
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If you attend group and the facilitator believes that you are under the influence of a substance, you will be asked to leave group.
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If you are mandated to treatment and sign a release, information such as: attendance, UA results, progress, and treatment goals will be shared with the mandating agency. We encourage and support clients in holding themselves accountable with their mandating agency.
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If you find yourself struggling with treatment goals, you and your counselor may look at other options for increasing your treatment activities and/or level of care.
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Phoenix Counseling Center requires an assessment to determine your level of care and individual and group sessions you will attend. If, during your time at PCC, you miss your scheduled sessions and/or don’t contact PCC for 30 days or more, another assessment will be required.
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We encourage you to check out 12-Step or other recovery programs during the course of your treatment.
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CONSENT FOR TREATMENT