M The following disclosure statement will provide you with some basic information regarding the process and procedures for participating in psychotherapy at A New Direction Counseling Services, P.A. Hopefully, many of your and concerns will be addressed in the information that will follow. You may also contact me directly to clarify or address any issues that you do not understand or may be unsure about. My Experience and Education I am a North Carolina Licensed Professional Counselor (#6581) a.

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How to fill out the NC New Direction Counseling Services Professional Disclosure Statement online

This guide provides a comprehensive overview of how to complete the NC New Direction Counseling Services Professional Disclosure Statement. Following these steps will help ensure that all required information is accurately filled out, allowing for a smooth intake process for psychotherapy services.

Follow the steps to successfully complete the Professional Disclosure Statement online.

  1. Press the ‘Get Form’ button to access the Professional Disclosure Statement and open it in your preferred online editor.
  2. Carefully read the introduction section, which outlines what to expect during your therapy at A New Direction Counseling Services.
  3. In the 'My Experience and Education' section, fill in any relevant details about your own background if necessary, or review the information provided about the counselor's qualifications.
  4. Next, review the 'Therapeutic Orientation' section to understand the methods utilized during therapy. You do not need to fill this out, but ensure you are aware of the therapeutic approaches mentioned.
  5. If applicable, read through the 'Couples Therapy' section. This part informs you about the specific therapeutic method used if you are seeking couples counseling.
  6. Examine the 'Fees, Insurance & Sessions' section that details the costs associated with services and insurance coverage. You may want to note your options and confirm any specifics with your insurance provider.
  7. Review the 'Confidentiality' section to understand the boundaries of confidentiality and its implications.
  8. Fill out the 'Availability' section with your preferred days and times if prompted by the form.
  9. Read the 'Process for Filing a Complaint' section to be informed about your rights.
  10. Finally, proceed to the 'Acceptance of Disclosure Statement' section. Sign and date the form where indicated, confirming your agreement to its terms. Ensure that both clients and the therapist complete their respective signature fields before finalizing.
  11. After filling out all necessary sections, use the options provided to save changes, download, print, or share the form as needed.

Take the next step in your mental health journey by completing the necessary documents online.

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What is the professional disclosure statement?

The purpose of a professional disclosure statement is to inform clients about your professional background and the limitations of your professional relationship.

The professional disclosure statement (PDS) is a document that an LPC, LMFT, registered associate, or temporary practitioner gives to each client that provides information about the practitioner and their practice.

Disclosure can take many different forms, but essentially it is a process of informing a prospective client about the qualifications of a counselor and the nature of the counseling process so that the client can make an intelligent decision regarding use of that particular counselor's services.

ORS 675.755 – Professional disclosure statement required.

Consent for Treatment I am informed about the policy regarding confidentiality of information I may disclose during counseling and the limits of that confidentiality. I understand that no promises have been made to me as to the results of treatment provided by this therapist.

I am informed about the policy regarding confidentiality of information I may disclose during counseling and the limits of that confidentiality. I understand that no promises have been made to me as to the results of treatment provided by this therapist.

The following are the required elements for documentation of the informed consent discussion: (1) the nature of the procedure, (2) the risks and benefits and the procedure, (3) reasonable alternatives, (4) risks and benefits of alternatives, and (5) assessment of the patient's understanding of elements 1 through 4.

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