Adult Informed Consent Information:

My Qualifications

Hello, I want to thank you for selecting me to assist you in renewing yourself, your marriage, your family, and/or your relationships. I am honored to have the opportunity to collaborate with you on a personal level and look forward to our time together. I am a Licensed Mental Health Counselor in the state of Florida and have completed a Master of Arts in Marriage & Family Therapy from Liberty University in Lynchburg, VA. I have counseling experience with individuals, couples, and groups facing mental health, marital, and substance abuse challenges.

The General Course of Counseling: Risks and Rewards

I appreciate that you have come to me and want to be thorough and specific in helping you. I believe that my job is to provide assessment and counseling while working conjointly with you to help you set and pursue your treatment goals.  It is true that in counseling, success depends on the client actively wanting to change. Counseling is not an exact science, and at times the counselor, in consultation with you may need to revise the goals of treatment. Assessment may be carried out during our first session and/or throughout treatment for further clarification of presenting problems.

The benefits of counseling include gaining an increased understanding of yourself, your partner, and/or other members of the family, as well as learning practical tools to help you thrive within those relationships and other situations of your life. This insight and practical application is intended to help you feel more prepared to deal with conflicts as they arise and more fulfilled with your relationships as a whole.

The risks of counseling include the possibility of increased stress for you, your partner, and/or other family members through the experience of uncomfortable emotions during counseling sessions and as you perform homework assignments. As a result, you could begin to rethink aspects of your life, relationships and consider change.

Payment

My fee is $160 per session, typically 55 minutes, payable by cash, check, or credit card, payment app (additional cc processing fee). I am an Out-of- Network provider for most insurance companies and will discuss my payment collection process briefly with you during our first session. A $25 Late Cancellation Fee will be assessed if cancellation notice is not received 24 hours prior to appointment.

Record Keeping and Confidentiality

Ethically and legally, I am required to keep records of all our contacts. Per federal/state regulations, you have the right to information generated between us. You must provide explicit permission and written consent for information to be released, unless the law specifies otherwise (see exceptions to confidentiality). Therefore, with your written consent, I will provide information to anyone with a legitimate need. Florida law requires that counseling records be maintained for 7 years. Then, because of space and privacy concerns, records are destroyed in compliance with state law and professional ethics.

Exceptions to Confidentiality

The following are legal/ethical exceptions to confidentiality:

-In case of suspected abuse (child, elder, and vulnerable populations); In case of danger to self or to others; In case of planning a future crime(s); Legal proceedings when counseling records may be subpoenaed; When a client signs a release of information; If a client sues a counselor or makes false charges against a counselor; When the client is a minor; When counseling a client who is terminally ill; When using non-encrypted email (i.e. gmail, yahoo, aol, etc.) or video conferencing (Skype, etc.); In a medical emergency

Client as a Consumer

As a client in counseling, you are encouraged to participate actively and fully in your own treatment. You are encouraged to follow through with as many homework assignments as are given. In addition, please keep me aware of times when you have not completed, or will not be able to complete, out-of-session assignments so that we can create a new plan. Also, if  you feel you do not fully understand something, ask me for clarification. Clients who take an active approach to their treatment are more likely to make therapeutic progress than those who wait passively for things to change.

Consent For Treatment:

I, the undersigned, certify that I voluntarily give my consent to attend counseling sessions and participate in the intake assessment interview and/or treatment in the outpatient counseling provided by David Reed, LMHC. By providing my signature below, I acknowledge that I have read, understood, and agreed to counseling services based on all information presented here in this informed consent document. I understand my rights as a client are protected by federal regulations.  I acknowledge and fully understand these rights.