Informed Consent for Counseling Services

LOVE COUNSELING CENTER
2145 S Military Trail · West Palm Beach, FL 33415
📞 (561) 827-2760 · ✉ lovecounseling@lovecounselingcenter.com
🌐 www.lovecounselingcenter.com

INFORMED CONSENT FOR COUNSELING SERVICES

Welcome to Love Counseling Center!
We are honored to support you on your journey toward emotional well-being, personal growth, and relational healing. This form outlines essential information about your rights, the counseling process, fees, and our policies.

1. PURPOSE OF COUNSELING
The goal of counseling is to provide a safe and supportive environment for individuals, couples, and families to address emotional, relational, and mental health challenges. Our licensed counselors help clients:

• Improve communication
• Resolve conflicts
• Foster intimacy
• Strengthen personal and family well-being

2. CONFIDENTIALITY
Your privacy is a priority. All sessions are confidential, except in these legal and ethical exceptions:

• Threats to harm yourself or others
• Suspected abuse of a child or vulnerable adult
• Court orders requiring disclosure

3. OUR APPROACH
We use a client-centered, evidence-based approach tailored to your needs. Sessions may include goal-setting, skill-building, emotional processing, and practical strategies for achieving lasting change.

4. TYPES OF COUNSELING OFFERED

• Individual Therapy: Personal support for emotional and relational concerns.
• Couples Therapy: Joint sessions to improve communication, resolve issues, and deepen intimacy.
• Family Therapy: Guided sessions to strengthen family dynamics and address conflicts.

5. CLIENT RESPONSIBILITIES
Successful counseling requires:

• Honest participation
• Openness to growth
• Commitment to the process
• Communication with your therapist about concerns

6. COUNSELING FEES
Standard Fees (Online or In-Person):

• Individual – 45 minutes: $125
• Individual – 60 minutes: $150
• Couples – 50–60 minutes: $200
• Extended Couples Session: $275

Sliding Scale Available:
We understand that financial situations vary. We offer income-based fees for clients who meet the qualification criteria. During your intake session, we will assess your financial circumstances and determine an adjusted rate that aligns with your needs and ability to pay.

Package Deals (Save More When You Commit):

• Starter Package: 3 Individual Sessions (60 min) – $405 (Save 10%; regular price $450)
• Couples Connection: 5 Couples Sessions (60 min) – $800 (Save 20%; regular price $1,000)
• Total Wellness: 10 Sessions (Individual or Couples) – $1,125 (Save 25%; regular price $1,500)

💳 Payment methods: Credit cards, electronic transfers, and all major insurance companies
📄 We provide superbills for insurance reimbursement (based on your coverage).

7. CANCELLATION POLICY
Please give at least 24 hours’ notice for cancellations. Missed appointments or late cancellations will incur a fee equal to the session cost.