Program Agreement & Informed Consent

Purpose of Premarital Counseling
The Built on the Rock™ Premarital Blueprint™ is an 8–10 session premarital counseling program designed to strengthen communication, deepen emotional connection, explore expectations, and prepare couples for a healthy marriage.

Program Overview

The program generally includes:

• Session 1 – Intake & Relationship Goals

• Session 2 – The Rock

• Sessions 3–4 – The Foundation

• Sessions 5–6 – The Pillars

• Session 7 – The Covering

• Session 8 – Rain, Storms & Floods

• Session 9 – Sunny Skies, Butterflies & Beach Days

• Session 10- The Final Inspection (Exam)

Additional sessions may be recommended based on the couple's needs.

Participation

Both partners agree to:

• Attend sessions together.

• Participate honestly and respectfully.

• Complete homework assignments.

• Practice relationship skills between sessions.

Participation is voluntary. Either partner may discontinue counseling at any time. The therapist may terminate services if counseling is no longer clinically appropriate or if attendance or participation becomes inconsistent.

Faith Integration

This program incorporates Christian principles.

Prayer, Scripture, and other faith-based interventions are included only with the agreement of both partners.

Telehealth & Jurisdiction

FaithWorks Therapy LLC provides telehealth services using HIPAA-compliant electronic health record, scheduling, payment, and video platforms.

Telehealth services are available only when both partners are physically located in a state where the therapist is licensed or otherwise authorized to practice.

Current states include:

Pennsylvania, Delaware, New Jersey, Texas, Nevada, Illinois, Georgia, Virginia, Maryland, and New York.

Both partners agree to:

• Participate from a private location whenever possible.

• Confirm their physical location at the beginning of each session.

• Notify the therapist before participating from another state.

• Understand that sessions may be canceled or rescheduled if services cannot legally be provided in their location.

Confidentiality

Premarital counseling is provided to the relationship rather than either individual.

Information shared during counseling is confidential except when disclosure is required or permitted by law, including:

• Abuse or neglect

• Court orders

• Serious risk of harm to self or others

The therapist generally does not maintain secrets between partners that would significantly impact the counseling process.

HIPAA Notice

FaithWorks Therapy LLC protects your Protected Health Information (PHI) in accordance with HIPAA.

Your information will only be used or disclosed as permitted by law or with your written authorization.

A complete Notice of Privacy Practices is available upon request.

Risks & Benefits

Potential benefits include improved communication, conflict resolution, emotional intimacy, trust, and relationship satisfaction.

Counseling may involve difficult conversations, emotional discomfort, or increased awareness of relationship concerns.

While every effort is made to provide quality counseling, no guarantees can be made regarding the outcome of counseling or the future success of your marriage.

Attendance & Cancellation Policy

Weekly attendance is encouraged.

Appointments canceled with less than 24 hours' notice, or missed without notice, will be charged 100% of the full session fee.

Payment is due at the time of booking.

Appointments booked without payment may be canceled.

Repeated late cancellations or missed appointments may result in termination of services.

Cancellations & Reschedules prior to 24 hours are accepted via email at sfarquharson@faithworkstherapy.com or Office phone: 302-303-2125

Electronic Communication

Email and text messaging are intended for scheduling and administrative purposes only.

Electronic communication cannot be guaranteed to be completely secure.

Urgent clinical concerns should not be communicated by email or text.

Emergencies

FaithWorks Therapy LLC does not provide emergency or crisis services.

If you are experiencing an emergency, call 911 or go to the nearest emergency department.

For mental health crises, contact the 988 Suicide & Crisis Lifeline.

Legal Proceedings

FaithWorks Therapy LLC does not provide custody evaluations, forensic evaluations, or expert testimony unless required by law or agreed upon in advance under a separate written agreement.

Consent
By signing this document, I agree 
I have read, understand, and agree to the Program Agreement & Informed Consent.

By checking this box, both partners acknowledge that they:

• Understand the counseling process.

• Understand the limits of confidentiality.

• Consent to participate in premarital counseling.

• Consent to telehealth services.

• Acknowledge receipt of the HIPAA Notice of Privacy Practices.

• Agree to the attendance, payment, cancellation, and practice policies.