Program Understanding
By enrolling in the HopeForWellness Program, participants acknowledge:
• Each participant will receive three (3) initial counseling sessions
• Continued sessions beyond the initial three are not guaranteed
• Provider assignment is based on availability
• HopeForWellness is a referral support program, not a clinical provider
Consent for Participation
I voluntarily request to participate in the HopeForWellness Program offered through New Hope Missionary Baptist Church.
I understand that:
• This program connects participants with licensed mental health professionals
• Services are provided by independent providers
• HopeForWellness does not provide direct clinical treatment
Liability Waiver
I acknowledge and agree that:
- HopeForWellness, New Hope Missionary Baptist Church, its staff, leadership, and volunteers are not liable for clinical outcomes resulting from services provided by independent mental health professionals.
- I understand that all counseling services are provided by licensed providers who operate independently of the church
- I release and hold harmless HopeForWellness and New Hope Missionary Baptist Church from any claims, demands, damages, or causes of action arising from participation in the program or services received.
Confidentiality Acknowledgment
I understand that:
• My personal information will be used solely for program enrollment and coordination
• My counseling sessions are confidential between myself and my provider