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The document is a Professional Disclosure Statement from C. Grace Hodgson, a Licensed Professional Counselor in North Carolina. It outlines her qualifications, therapeutic approaches, confidentiality policies, session details, fees, insurance billing practices, and ethical considerations. Hodgson emphasizes her experience in various counseling areas and her belief in the value of each individual from a spiritual perspective.

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What is an example of a disclosure statement?

I hereby certify that, to the best of my knowledge, neither I (including any member of my immediate family) nor any individual or entity with whom or wijt h which I have a significant working relationship have (has) received something of value from a commercial party related directly or indirectly to the subject of

What is a professional disclosure statement?

I will keep confidential anything that you say to me, with the following exceptions: a) you direct me to tell someone else, b) I determine that you are a danger to yourself or others, c) I am ordered by a court to disclose information, d) I suspect or am made aware of physical/sexual abuse of minors, persons with

What do you write in a disclosure statement?

A disclosure statement is usually also part of a loan, stating details of the transaction such as the interest rate, fees, the amount borrowed, loan insurance, any prepayment rights, and the borrowers responsibilities.

Which of the following should be included in a professional disclosure statement?

A Professional Disclosure Statement is a printed document that includes the following information: (1) name of licensee or applicant; (2) the licensees or applicants highest relevant degree, year degree received, discipline of degree, and name of institution granting the degree; (3) names and numbers of all relevant

What is an example of a disclosure statement for a counselor?

A professional disclosure statement for therapy, also known as an informed consent statement, defines the terms and conditions of the therapist-client relationship. First, professional disclosure statements safeguard the interests of both therapists and clients.

example of professional disclosure statement

Professional Disclosure Statement counseling Michigan example Professional Disclosure Statement School Counseling example Professional Disclosure Statement counseling student Personal Disclosure Statement example Professional Disclosure Statement counseling Intern Professional Disclosure Statement for mental health Counselors Professional Disclosure Statement Social work LCMHCA Professional Disclosure Statement

Is a professional disclosure statement the same as informed consent?

To be licensed as a LCMHC in the state of North Carolina an individual must meet the following requirements: Application (Rule . 0305) Education (Rule . 0701) Exam (Rule . 0305) Professional Disclosure Statement (Rule . 0204) Verification of Supervised Professional Practice (Rule . 0205)