Disclosure Statement And Consent For Counseling Services printable pdf download

DISCLOSURE STATEMENT AND CONSENT FOR COUNSELING SERVICES

Welcome. This document contains important information about our professional services and business practices

at Counseling Services. Please keep a copy of this information for your records. When you sign this document, it

will represent an agreement between us.

About Counseling. WSU Vancouver Counseling Services counselors are available to assist students with

problems and concerns that may arise while a student at WSU Vancouver. Our trained counselors have experience

working with a diverse population with a variety of psychological concerns, such as depression, bipolar, anxiety,

ADHD, bereavement, relationship concerns, disordered eating and body image concerns.

We offer short-term individual and couples counseling, group counseling, psychological testing, and crisis and

consultation services. Same-day urgent appointments are available to students in acute distress. We also assist

students by referring them to other services on campus and to community resources that can offer more specialized

or longer-term assistance with problems and concerns.

Counseling is a collaborative interaction with a counselor who can help to improve your life through healthier

relationships, better communication, greater understanding of self, strategies for self-care, and in making choices

that are more consistent with your educational and personal goals. Together, you and your counselor will discuss

your needs, including the type of counseling, goals and strategies to meet those goals, and counseling duration. Both

you and your counselor have a shared responsibility to positively impact your counseling.

Our Counseling Staff. Our counselors include licensed psychologists and doctoral student trainees who work

under the clinical supervision of our professional staff. If it appears that another counselor might be a better fit for

you, your counselor or the counseling staff can arrange a transfer for you. If it appears that your needs cannot be

met at Counseling Services, we will be happy to facilitate a referral to a community provider.

Confidentiality and Privacy. Counseling is private and confidential, and any contact with, or information shared

with any of the members of Counseling Services is not exchanged with anyone else without your written permission

(RCW 70.02.020). Please note that in order to coordinate the best services for you, we may consult with other

Counseling Services staff without your written permission.

In all but a few rare situations, your confidentiality is protected by federal and state laws and by the ethics of our

profession. The exceptions to this are:

If we believe you are in imminent danger of causing harm to yourself or someone else, it is our legal and

ethical responsibility to act to keep you safe, which may necessitate the release of confidential information.

We may contact emergency personnel, family, or significant others, including the emergency contact person

you identified on your Client Information Form, to facilitate maintaining your safety and the safety of

others.

2. If we have reason to believe that a child or vulnerable adult has suffered abuse, exploitation, or neglect; or

is in imminent danger of suffering abuse, exploitation, or neglect; we will report the incident (or cause a

report to be made) to the proper law enforcement agency.

3. If a court of law compels a release of records through a subpoena, we are legally required to comply and will

make the records available to the court and involved legal professionals.

Otherwise, information can be released only if you sign a form that authorizes a release and specifies what is to be

released. Under most circumstances the release is valid for 90 days and can be revoked at any time at your written

request.

Disclosure Statement And Consent For Counseling Services