TERMS AND CONDITIONS
Mode of Sessions:
I understand that this therapy service is conducted online via Google Meet.
Limits of Confidentiality:
What you discuss during your therapy session is kept confidential. No contents of the therapy sessions, whether verbal or written may be shared with another party without your written consent or the written consent of your legal guardian. The following is a list of EXCEPTIONS:
• Duty to Warn and Protect
If you disclose a plan or threat to harm yourself, the therapist must attempt to notify your family and notify the legal authorities. In addition, if you disclose a plan to threaten or harm another person(s), the therapist is required to warn the possible victim(s) and notify legal authorities.
• Abuse of Children and Vulnerable Adults
If you disclose, or it is suspected, that there is abuse or harmful neglect of children or vulnerable adults (i.e. the elderly,
disabled/incompetent), the therapist must report this information to the appropriate state agency and/or legal authorities.
Referrals:
If I or the therapist determines that a referral is needed, the therapist will provide alternatives including programs and/or other professionals who may be able to assist me. In cases where coordination of professional services is required, any exchange of information will be made only with express permission from me.
I have had the opportunity to read “Terms and Conditions” and I agree with all of the provisions contained above. I understand that if I have any reservations, I should not sign this statement.