I understand that the service provided through Phoenix Inspirations, LLC is not intended for crisis situations and urgent needs. In a crisis situation, I agree to call 988 or local emergency services, or visit the nearest emergency room.

Informed Consent for Therapy Agreement

Please read through the following informed consent agreement. What follows is a basic understanding between the client and therapist. In general, what is listed below are the responsibilities and obligations of your therapist and also some expectations of you as the client. This document also contains important information about professional services and business policies. I will need to collect from you at our first session general information that will be required for proper identification and emergencies, including full name, address, contact information, and an emergency contact with phone number. When you sign this document, it will represent an agreement between us.

Counseling

Voluntary Participation: All clients voluntarily agree to treatment and may terminate at any time without penalty. In the first couple of sessions, you should be deciding whether this therapy is right for you, or if you feel it is not a good match, then I will be happy to assist you in finding a new therapist.

Client Involvement: All clients are expected to show up to the appointments on time, be prepared to focus on and discuss therapy goals and issues, and will not attend while under the influence of mood-altering chemicals. All clients are expected to be open and honest so I can assist you with your goals. Counseling is not like a medical doctor visit. Instead, it calls for a very active effort on your part. In order for therapy to be most successful, you are encouraged to work on things we talk about both during our sessions and at home. Inconsistent attendance can negatively affect your therapy progress.

Therapist Involvement: I will be prepared at the designated times (barring emergencies), and will be attentive and supportive in meeting the therapy goals and do everything possible to assist you in achieving a greater sense of self-awareness and work toward helping you resolve problem areas.

Guarantees: Although most people get better in therapy, some do not. I do not guarantee results as it is impossible to guarantee to become happier, saving marriages, stopping drug abuse, becoming less depressed, and so forth.

Risks of Therapy: Just as medications sometimes cause unexpected side effects, counseling can stimulate painful memories, unanticipated changes in your life, and uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. Another risk of therapy is that through the process of therapeutic change, it is not uncommon for clients to reach a point of change where they may feel they are different and no longer able to be the same person they were upon entering therapy. At times, these feelings can be unsettling.

Benefits of Therapy: The benefits of therapy can include a higher level of functional coping solutions to specific problems, new insights into self, more effective means of communicating in relationships, symptomatic relief, and improved self-esteem. Alternatives to Traditional Therapy can include stress management, twelve-step programs, peer self-help groups, bibliotherapy, mindfulness, and support groups.

Credentials and Qualifications: I hold a Master's degree in Clinical Mental Health Counseling and am currently pursuing my PhD in Social Psychology. I am a Licensed Professional Counselor licensed by the State of Georgia to provide counseling based on my training and education.

Counseling Approach & Theory. I use a variety of therapy approaches based on the client's needs, strengths, and abilities, which includes a Cognitive-Behavioral and Humanistic orientation to counseling. I will focus largely on building a relationship with clients, creating a nurturing environment conducive to change, exploring past events and how they continue to affect you today, analyzing underlying belief systems and their relation to inadequate functioning or hindrance to change, and implementing specific emotional, cognitive, and behavioral techniques designed to aid in change toward specified goals.

Colleague Consultation: In keeping with standards of practice, I may consult with other mental health professionals regarding the care and management of cases. The purpose of this consultation is to ensure the quality of care. I will maintain complete confidentiality and protect your identity by not using real names or any identifying information.

Meeting and Length of Therapy: Once we have agreed to work together, we will usually schedule one appointment every 1 - 2 weeks at an agreed-upon time. The session length, in most instances, is 55 minutes. Because our meetings are your time, you are expected to come to each session with a sense of what it is you would like to discuss or work on during that particular session. The length of therapy is quite variable based on client motivation, the number and severity of issues to resolve, and work efforts outside of the therapy sessions. My current schedule is Monday, Tuesday, and Wednesday from 8 a.m. to 6 p.m.

Confidentiality and Privilege: The information and content shared in therapy will remain confidential, except as noted in the next section: Exceptions to Confidentiality and Privilege. Your information will not be shared with anyone without your written consent. Your information is also privileged, which means that I am free from the duty to speak in court about your counseling unless you waive that right or a judge orders it.

EXCEPTIONS TO CONFIDENTIALITY AND PRIVILEGE

As a mandated reporter in the state of Georgia, I am legally obligated to violate confidentiality under the following circumstances: * When the therapist has reason to suspect that the client has been, or is currently, involved in the abuse or neglect of a child * When the therapist has reason to suspect that the client has been, or is currently, involved in the abuse or neglect of vulnerable adults * If a client is pregnant and taking street drugs * If the client is a serious danger to themselves, i.e., if suicidal * If a client is a serious danger to someone else, i.e., if homicidal * If the courts order copies of records

Ethical Guidelines: I follow the American Counseling Association (ACA) ethical guidelines and those dictated in the Georgia Licensing Board rules and regulations. Copies of these materials are available on the organization's website. (www.counseling.org; www.sos.ga.gov).

Therapeutic Records: The laws and standards of this profession require that I keep treatment records. You are entitled to receive a copy of the records unless we believe that seeing them would be emotionally damaging, in this case, we will send them to a mental health professional of your choosing. Because these are professional records, they can be misinterpreted and/or upsetting to untrained readers. We recommend you review them in that therapist's presence so they can discuss the contents. All client records include a data sheet required to be filled out prior to therapy (Full Name, address, Date of Birth, home/cell phone number, and emergency contact name and number), a chronological listing of appointments, a copy of signed releases, copies of any correspondence regarding your case, a copy of the signed informed consent packet materials, and a copy of all therapy notes. This therapist will maintain all records in a secured area for a period of seven years from the time of service termination. You have a right to contest material in your records, which will be duly noted. You do not have a right to alter your records or dictate information be removed. You have the right to access and view your record, but you do not own the records. They are the property of the therapist.

Supporting Vendors: While operating as a therapist, I contracted with an external vendor to use an electronic health record (EHR) (iCANotes) and for credentialling with insurance company’s and billing (Headway). These vendors are in compliance in all regards with HIPAA guidelines and understand confidentiality. They agree to abide by those regulations as set forth and maintain the same level of confidentiality that healthcare professionals are bound to in the event they encounter client information. Their systems are electronically automated, and the EHR vendor, like most EHR vendors, has restricted access and is not able to access patient narrative notes.

Professional Fees: All session fees are managed through Headway, and any questions or concerns regarding this should be addressed to them.

Phone Availability: I am often not immediately available by phone. Because of other obligations, sessions, or groups, I typically will only return emergency phone calls in the evening. You can leave messages for me on my phone, or through email, and make every effort to return your call the same day you have messaged/called, except for some weekends and holidays. Phoenix Inspiration, LLC is not intended for crisis situations and urgent needs. In a crisis situation, I agree to call 988 or local emergency services or visit the nearest emergency room.

Emergency & Interruption of Therapy: In the event of an emergency and when on vacation or plan to be unavailable for a brief period of time, I will provide you with the information for another therapist you can contact with questions or see as needed. In the event of a longer interruption of therapy, I will make appropriate referrals as needed.

Termination: Either the client or I may end therapy at any time. Your voluntary involvement allows you to discontinue at any time. If you appear to no longer benefit from therapy or if there is a conflict in values, then I may discuss termination. If you desire additional counseling, I will provide you with a competent referral to address your issues.

Client Satisfaction Survey: I welcome feedback about the services you receive, and I am dedicated to improving the delivery of service to clients. At various times, you may receive a request to complete a satisfaction survey, and I urge you to complete it.

Encounters outside of the Therapeutic Setting: If at any time we run into each other in the community. I will protect your confidentiality by not speaking to you or acknowledging you in any way. If you wish to talk with me, you are welcome to initiate that contact. If you wish to talk with me, I will keep our encounter as brief as possible. In addition, ethical guidelines discourage social or business interactions between counselor and client outside of the context of therapy. While I care deeply about working with you, I am not in a position to be your friend or have any social or personal relationship with you. Any gifts bartering and/or trading for service is not considered appropriate and will not be engaged in.

NOT ALL forms of communication are considered confidential. I prefer not to communicate through mobile/cell phone, text messaging, or social media sites, such as Facebook, Twitter, LinkedIn. These sites are not secure and may compromise your confidentiality. If you decide to engage in these forms of communication, I assume that you are aware of and accept the possible risk to confidentiality through this form of communication. I will only reply in order to direct you to the Better Help platform for further communications.