Consent for Service

I understand that:

• I can ask questions about anything related to my therapy.
• I can decline any therapeutic techniques at anytime.
• I can discontinue therapy, and return without impediment.
• I can review my records related to therapy.
• I can raise any concerns and be treated with respect and dignity.
• I can expect confidentiality within the limits of the law (see Limits of Confidentiality).
• The therapist has the right to dismiss a client from therapy. In the event of that occurring, the therapist will provide an explanation and opportunity for discussion about the termination.

Limits of Confidentiality

1. When there is an imminent danger to the client or another person
2. When there is abuse or neglect of a child
3. When the therapist has been summoned by a court order
4. When a Release of Information has been completed by the client