• Therapy Consent

    Therapy Consent

  • I understand that I am engaging in therapy services and I may experience strong feelings as I discuss concerns and things I may want to change. I may also see changes in relationships that can be upsetting.

    | have been told that what I talk to my therapist about is kept private. I have been told that there are exceptions to what is kept private and that in the case of a medical emergency, child/elder abuse or neglect, harming myself/others, my request to release records, or under court order, my information may be released.

    My therapist and I have discussed the following expectations for therapy sessions:

    • My therapist and I will create goals together.
    • When therapy goals are met, it will be determined if there are other appropriate goals for therapy or if it is appropriate to end therapy.
    • If I believe that my therapy is not working, I will talk to my therapist about this so we can make the appropriate changes and work on the concern.
    • I will do my best to share openly during sessions

    My therapist and I have discussed the following guidelines:

    • Appointments are 50-55 minutes unless otherwise specified with the therapist. I will be marked a no show 15 minutes after the appointment time. Shorter appointments have a 10 minute no show period.
    • I will do my best to call 24 hours in advance to change or cancel my therapy sessions or I maybe charged a fee of $50. I understand I am subject to a $50 no-call no-show fee.
    • During therapy sessions I will not be on my cell phone with the exception of telehealth sessions
    • I will be in a secure, private place to hold a therapy session during telehealth sessions
    • I will communicate with my therapist or the office if I miss an appointment. If I cannot be reached after 2 attempts, I will be removed from active caseload.

    Higher Peaks Counseling accepts and returns calls Monday-Friday, 8AM-7PM except on major holidays or if an appointment is scheduled. If I need extra support after hours, I have been informed of the following crisis line information and can ask for additional resources in session. If I choose to contact Higher Peaks via e-mail or via website, please be aware that e-mail is not a secure means of communicating sensitive mental health information.

    Community Wide Crisis Line: 988 Open 24 hours, 7 days a week

     

  • Powered by Jotform SignClear
  •  / /
  • Should be Empty: