Client Agreements

Updated: August 7, 2022

CONSENT FOR TREATMENT

BENEFITS AND CONSEQUENCES FOR COUNSELING/COACHING

Persons contemplating counseling/coaching should realize clients frequently make significant changes in their lives. Upon making changes, clients often modify their emotions, attitudes, beliefs, and behaviors. Clients may notice symptoms getting worse before getting better. Because of counseling, clients may begin to feel differently about themselves and alter aspects of their lives. Your therapist/coach cannot guarantee a specific outcome; clients are ultimately responsible for their own growth. If you have questions about the benefits and consequences of counseling, please feel free to ask and discuss these issues with your therapist/coach.

I understand my participation in individual, group, or family therapy/coaching is voluntary. I may terminate the therapeutic relationship at any time and will discuss any reasons for doing so with my therapist/coach at Conscious Living, LLC.

I understand all information is held in strict confidence and is only released by my written permission to specific persons or institutions for specific reasons. I further understand there are some exceptions to confidentiality, which are mandated by state statute.

I further acknowledge my consent to and seek treatment with Conscious Living, LLC until such time as treatment goals are met or other reasons for termination of services have been specified. I understand counseling/coaching is a mutual relationship, which may be terminated by either party for specified reasons.

IMPORTANT INFORMATION REGARDING TREATMENT

The length of time you spend in counseling/coaching will depend on your specific needs. Your therapist/coach will work with you to create an individualized plan to outline your expectations and set reasonable time frames for achieving your desired goals.

Participation in counseling/coaching is not guaranteed to be successful and may open emotionally sensitive areas.

Due to the limits of this outpatient practice, if you regularly require contact or emergency care between sessions, you may be transferred to a provider that can offer more intensive care.

LIMITS OF CONFIDENTIALITY

It is mandated by state and federal regulations (through duty to warn) to breach confidentiality if there is mention of any of the following: 1.) You are a danger to yourself. 2.) You are threatening to harm another person. 3.) It is reported or suspected that a child or vulnerable adult has been or is being abused/neglected (within the preceding 3 years) 4.) You have or intend to commit a serious crime.

Your therapist/coach may, at times, feel it necessary to consult with another professional, such as your attorney, physician, or another counselor. If this is needed, the reason for contact will be discussed with you and you will be asked to sign a written consent delineating the type of information that can and cannot be shared.

Electronic messages, such as email and text, are commonly used and convenient forms of communication. Please be advised although a confidentiality notice is provided on outgoing messages and precaution is used in guarding your information, digital records cannot be fully protected. Also, digital records are considered to be part of your file in legal cases and can be subpoenaed as part of your record. Therefore, it is highly recommended you limit the content of emails and texts to information that would not be personal in nature, such as regarding the scheduling of an appointment.

SCHEDULING

You may schedule an appointment at Conscious Living, LLC through the following web address: https://consciouslivingllc.as.me/. You may also opt in for e-mail reminders for your appointments.

CANCELLATION POLICY

When needing to cancel, a 24-hour notice is required or you will be charged the full amount for the session. While reasons for missing appointments may be valid, you will still be financial responsible for this time as it is allocated specifically for you.

EMERGENCIES

Your therapist/coach may not always be available in emergency situations in between sessions. If you are in a situation in which your physical health may be threatened, call 911 or find a safe way to go to your nearest emergency room. If you do not have an immediate health risk but feel your need is urgent, the following resources are available 24 hours a day:

• Suicide Hotline: 988

• Crisis Text Line: Text HOME to 741741

FEES/PAYMENT POLICY
I understand I am expected to pay $155/hour for each individual session, $185/hour for each couples/two-person-family session, and $225/hour for each 3+person family session. I understand I may pay through a variety of payment methods such as cash, credit/debit cards, Venmo or PayPal. I understand a credit card will be placed on file through Acuity’s secure portal and will be used as a form of payment unless otherwise specified or requested. I also give permission for Conscious Living, LLC to charge this card in the event I fail to show for a session or do not cancel within a 24-hour period. Payment is due at the end of each session or I may opt to pay in full when scheduling my appointment through Acuity.

I understand any returned checks or credit/debit card denials may be subject to additional collection fees. I also understand upon termination of treatment any remaining balance is immediately due. If the balance is not paid within 90 days, I understand my account will be sent to a collection agency.

I understand Conscious Living, LLC does not currently accept insurance, but I can be provided with a Statement of Services to submit to my insurance company (for therapy clients in South Carolina only) for reimbursement. I am aware it is my responsibility to determine what my insurance offers for out-of-network providers.

I understand any coordination of care outside of sessions (including contact with other treatment providers, writing letters on client’s behalf, or other tasks necessary for optimal and ethical treatment of client) will be subjected to a prorated fee to provider’s hourly rate.

CONFIDENTIALITY
Your session is always held in confidence. Professional Ethics and South Carolina State Law indicate that confidential information is controlled by the client. This means that, as a general rule, information shared in sessions with a coach/therapist will be held in confidence. There are two exceptions to this general rule. In the case of an emergency where I believe a client is at risk of hurting him/herself or another person, there may be a breach in confidentiality. South Carolina law requires that child and elderly abuse in any form be reported to the Department of Human Services.