Disclosure Statement And Consent For Counseling Services (Page 2 of 3) in pdf

Notice of Information Practices. We keep a record of services we provide you (RCW 70.02.120). We will not

disclose your record to others unless you direct us to do so or unless the law authorizes us to do so. You may ask to

see a copy of your record and you may ask us to correct that records. If you wish to do so, please contact the lead

psychologist, Dr. Patience McGinnis.

Supervision/Consultation. Doctoral level trainees provide counseling services and have their work reviewed by

a licensed psychologist in accordance with state and professional guidelines. A doctoral level trainee will ask for

permission to record your sessions to review with his/her clinical supervisor. This is done for training purposes only

and will not be shown outside of Counseling Services. The recordings are erased or destroyed after review by the

counselor and supervisor and no later than the end of the semester in which they are made. You will be asked to

sign an additional form authorizing permission to do this; your agreement to be recorded is voluntary. If you have

questions about this please discuss this with the lead psychologist, Dr. Patience McGinnis.

Client Information. When you first come in to meet with a counselor, or if it has been a long time since your last

appointment, we will ask you to provide personal information on a Client Information Form, Initial Assessment

Form, and Counseling Center Assessment of Psychological Symptoms (CCAPS), either electronically or in hard

copy. The information you provide will assist our counselors in understanding your concerns and how we may help

meet your needs.

Client Rights. You may ask to change counselors at any time. Your counselor will be happy to discuss with you his

or her theoretical or therapeutic orientation and the proposed treatment, including any risks, requirements, or

expectations that might exist. You have the right to receive care that is nondiscriminatory and the right to

confidentiality.

As indicated above, we keep a record of the services we provide you. Our records are stored in locking file cabinets

within Counseling Services. Some of the information you give to us may be stored in electronic format or is managed

electronically. We strive to protect the security of our records and maintain practices in accordance with federal and

state guidelines. We use appropriate firewall protection, data encryption and password protection to insure the

privacy of your information. You may ask us for more information about how our records are stored or transmitted

or to review your record. You also may ask us to correct that record if you find it to be in error. If there is a breach

of security of your records, you have the right to be informed of that breach.

First session. You will be scheduled for an initial assessment to

get a broad understanding of your

concerns. The

length of this appointment will be approximately 45-50 minutes.

At this first appointment, counselors ask standard

intake questions to help gain an understanding of your situation and concerns and decide with you the most

appropriate resources for assisting you, either within Counseling Services, through other services on campus, or in

the community. If it is determined that Counseling Services provide the most appropriate services for your concerns,

the counselor you see at your initial assessment may schedule a follow-up appointment with you or may refer you

to another counselor within Counseling Services.

Your counselor will work with you individually to determine the

goals, duration, and best methods of counseling. We also maintain current information on psychological services in

the community for students who request extended counseling or services by a therapist with particular expertise.

Individual counseling sessions. Short-term individual counseling (beyond the initial intake) is offered based

on a variety of factors (e.g., availability, client-therapist fit, and level of care needed for treatment). Based on these

factors, WSU Vancouver Counseling Services counselors will provide students with brief individual therapy services,

or will provide referral resources within the community, for continued off-campus health-related services. The

length of individual counseling session will be approximately 45-50 minutes.

Evaluation of Services. Evaluating our services helps us to maintain their quality. You are encouraged to give

individual feedback to your counselor at any time. In addition, you may be asked to fill out a short questionnaire

regarding your counseling experience.

Use of Email. Counseling Services occasionally uses email to contact clients about scheduling issues or other clinic

business, such as surveys. If you do not wish to receive these emails, please do not provide your e-mail address on

the Client Information Form you complete today.

Fees and Eligibility. Currently enrolled WSU Vancouver students are eligible for mental health counseling. The

counseling services are free.

Page 2 of 3

Disclosure Statement And Consent For Counseling Services Page 2

Related Articles

Related forms

Related Categories