Disclosure Statement for Licensed Mental Health Professional - Washington
About this form
The Disclosure Statement for Licensed Mental Health Professionals in Washington is a document designed to inform clients about the treatment methods, fees, confidentiality agreements, and their rights in the therapeutic relationship. It is a vital tool for mental health counselors who use eclectic approaches in therapy, ensuring clients are fully aware of what to expect from their sessions.
Form components explained
- Client rights and responsibilities, including the right to refuse treatment.
- Approach to treatment detailing the eclectic methods used based on client needs.
- Education and experience of the counselor, indicating qualifications and therapeutic focus.
- Fee information, including session costs and billing procedures.
- Confidentiality provisions, outlining limits on confidentiality in specific circumstances.
- Telehealth guidelines, describing the use of technology in therapy sessions.
When to use this document
This form should be used by licensed mental health professionals when initiating a counseling relationship with a client in Washington State. It is essential during initial sessions, particularly when the counseling method is eclectic, which requires clarity about the counselor's approach and the client's rights.
Who needs this form
- Licensed mental health counselors providing eclectic therapy in Washington State.
- Clients seeking mental health services and wishing to understand their treatment plan.
- Individuals or families experiencing relationship, emotional, or psychological issues.
Steps to complete this form
- Enter the licensed mental health counselor's name and license number at the top of the form.
- Review the Client Rights section to understand your rights as a client.
- Discuss the approach to treatment during your first session and fill out the appropriate treatment plan together.
- Sign and date the form to acknowledge receipt of the disclosure and your understanding of its terms.
- Keep a copy of this form for your records as it outlines essential information about your counseling relationship.
Notarization requirements for this form
This form does not typically require notarization to be legally valid. However, some jurisdictions or document types may still require it. US Legal Forms provides secure online notarization powered by Notarize, available 24/7 for added convenience.
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Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.
Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
Common mistakes
- Skipping the review of fees and insurance policy details before the first session.
- Neglecting to ask questions during the initial assessment about treatment methods.
- Failing to keep track of appointment cancellations which may incur fees.
Why complete this form online
- Convenient access to the form any time, allowing for easy completion and return.
- Ability to edit and customize the form as per individual therapy needs.
- Reliability of professionally drafted content, ensuring compliance with Washington laws.
Legal use & context
- This disclosure form ensures that mental health professionals meet state requirements for transparency with clients.
- It establishes a clear understanding of treatment parameters, which can help in addressing any legal issues that may arise.
- The form enhances the therapeutic relationship by fostering trust and open communication between the counselor and client.
Key takeaways
- This form is essential for licensed mental health professionals in Washington to communicate with clients effectively.
- Clients should utilize this form to understand their treatment options, rights, and counselorâs qualifications.
- Completing the form is a collaborative effort that sets the stage for a productive counseling relationship.
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FAQ
ORS 675.755 - Professional disclosure statement required.
I will keep confidential anything that you say to me, with the following exceptions: a) you direct me to tell someone else, b) I determine that you are a danger to yourself or others, c) I am ordered by a court to disclose information, d) I suspect or am made aware of physical/sexual abuse of minors, persons with
The purpose of a professional disclosure statement is to inform clients about your professional background and the limitations of your professional relationship. It is sometimes referred to as a document of informed consent.
The professional disclosure statement (PDS) is a document that an LPC, LMFT, or registered associate gives to each client that provides information about the licensee/registered associate and their practice. Who must have a PDS? Every applicant for licensure must submit a PDS as part of his or her application.
A disclosure statement is a financial document given to a participant in a transaction explaining key information in plain language. Disclosure statements for retirement plans must clearly spell out who contributes to the plan, contribution limits, penalties, and tax status.
What is the The Professional Disclosure Statement? The name, title, business address, and business telephone number of the professional clinical counselor, professional counselor,
The informed consent agreement Any issues related to purposes, goals, techniques, procedures, limitations, potential risks, and benefits. The counselor's qualifications, credentials, relevant experience, and approach to the counseling they're providing.
WAC 246-809-710 Required disclosure information. (m) The licensee must provide department of health contact information to the client so the client may obtain a list of or copy of the acts of unprofessional conduct listed under RCW 18.130. 180.
