MINDIE WELLNESS - MENTAL HEALTH CONSENT
UNDERSTANDING COUNSELING:
I understand that:
- Counseling involves discussing personal matters
- Progress requires active participation
- Results cannot be guaranteed
- Sessions are confidential with noted exceptions
CONFIDENTIALITY LIMITS:
I understand confidentiality is broken ONLY when:
1. I pose danger to myself
2. I pose danger to others
3. Child/elder abuse is suspected
4. Court orders disclosure
5. I provide written authorization
ONLINE COUNSELING RISKS:
I acknowledge:
- Technology failures may occur
- Internet security cannot be 100% guaranteed
- Video quality may vary
- Sessions recorded only with my consent
SCOPE OF SERVICE:
I understand this service:
- Is NOT for emergencies
- Is NOT a substitute for in-person care when needed
- May require referral for specialized treatment
- Does not provide prescriptions or medical diagnosis
MY RESPONSIBILITIES:
I agree to:
- Attend sessions as scheduled
- Participate honestly and openly
- Notify counselor of suicidal thoughts
- Use emergency services when needed
- Provide 24-hour cancellation notice
COUNSELOR QUALIFICATIONS:
- All counselors are qualified professionals
- Credentials available upon request
- Supervised by licensed practitioners
RIGHT TO REFUSE:
I may:
- Refuse to discuss certain topics
- End counseling at any time
- Request different counselor
- Ask questions about treatment
CONSENT:
By checking this box, I confirm:
- I am 18+ years old
- I have read and understand this consent
- I voluntarily agree to counseling services
- I understand confidentiality limits
- I know how to access emergency services