Welcome to Unleashing Your Potential services. We are delighted that you have chosen to work with us and excited to begin our journey together. This letter will provide you with logistical information about our policies and procedures and ensure a mutual understanding about our professional relationship. Please take a few minutes to read through this informed consent form to understand more about counseling and get to learn more about the solutions that can address your concerns to get you back on track.

COUNSELING. Counseling is a process carried on in a one-on-one social engagement between a professional known as counselor or therapist, acting to help a client or couples seeking to learn more about himself or herself, exploring difficulties, and to understand the society that surrounds himself or herself in reaching defined positive goals and values for a better chance to become a productive member of society.Other possible benefits may be a better ability to cope with marital, family and other interpersonal relationships.

BENEFITS OF MARRIAGE COUNSELING. Marriage counseling helps couples of all types recognize and resolve conflicts and improve their relationships. Through marriage counseling, you can make thoughtful decisions about rebuilding and strengthening your relationship or going your separate ways.Marriage Counseling is a collaborative process and the progress you make will depend in large measure upon your investment in the process.

RISKS OF COUNSELING. There are certain risks involved in counseling. You may experience a variety of negative emotions during therapy as you remember and therapeutically resolve unpleasant events. Seeking to resolve concerns between family members, marital partners, and other persons can similarly lead to discomfort as well as relationship changes that may not be originally intended. The greatest risk of counseling is that it may not by itself resolve your concerns. Unleashing Your Potential will do our best to assess progress and provide referrals to other sources if that is deemed necessary and appropriate. 

CONFIDENTIALITY. We highly respect the privacy and confidentiality of each of our clients. We likewise believe that for counseling to be effective and successful, we must make our clients feel secure about the information that they disclose with us. We keep our clients' records in a secure manner and we do not allow it to be accessed or to be shared with anyone else unless with the written consent of our client who owns the information, both clinical information and personal. If records receive no update within a period of 7 years, we purge the records for privacy protection. However, we would like to let you know that privacy has its limitations in law and we would like to inform you of the circumstances where we may share information to a 3rd party without your consent: Acts of sexual abuse or misconduct Criminal acts Acts of abuse towards others such as neglect towards children, disabled, or the elderly Acts that the therapist believe may cause harm to the client himself or to others Compelling legal orders by the court, but nonetheless we will inform the client immediately prior to compliance with the order. 

SESSION APPOINTMENTS. Each session takes 1 hour. Counseling sessions are on the reservation and by appointment. In case the client will not be able to attend the scheduled appointment, he/she should call 24-hours prior appointment or he/she will be charged 100% of the session fee.

FEES. Fees are charged on a per session basis. If you planning to pay, here are our schedule of fees: • 1-hour Sessions. Please review website for updates on fee changes per services. 

COST OF SERVICE – Marriage & Pre- Marital Counseling- The cost of service is $100.00 per session.

Workbook/Curriculum there will be a one-time $15.00 fee for the couple’s workbook

Anger Management- fees are determined by class or individual sessions. Please contact facilitators for clariforcation.

Workbook/Curriculum for Anger Management $15.00 plus shipping fee if needed

PAYMENT OF FEES All fees should be paid at the time the service is rendered. We accept Payment through invoice payment system - Paypal, Cash App- (Unleashing Your Potential). You are also responsible for paying the service fee of $5.00

INSURANCE: Please remember that you are responsible for payment of all fees (self - pay), we do not accept insurance

CANCELLATIONS: Cancellations must be made twenty-four hours in advance to avoid charge. Missed appointments will be charged the regular fee.

Anger Management: if you missed two classes, you would have to restart your classes

RELATIONSHIP. The relationship required for effective counseling is strictly professional. This is for the best interest of the parties. The therapist cannot have any other relationship with the client than a professional one. 

CONSENT I understand that this consent is purely voluntary. I have had the opportunity to discuss any concerns with regard to the services and treatment and by which all questions were answered accordingly and to my satisfaction.  I understand that I can withdraw anytime from the therapy by informing my therapist. By signing below, I expressly give my consent to the treatment and therapy sessions with the therapist.