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Professional disclosure statement counseling example

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The document is a Professional Disclosure Statement from A New Direction Counseling Services, P.A., outlining the psychotherapy process, therapist qualifications, therapeutic orientations, and specific methods used in couples therapy, particularly the Gottman Method. It details fees, confidentiality policies, availability of services, and the process for filing complaints. The statement emphasizes the importance of client understanding and consent regarding therapy terms.

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Click ‘Get Form’ to open the Professional Disclosure Statement in the editor.
Begin by reviewing the introductory section, which outlines the purpose of the document and provides contact information for any questions.
Fill in your personal details in the 'Acceptance of Disclosure Statement' section, ensuring you understand each component before signing.
In the 'My Experience and Education' section, read through the counselor's qualifications and areas of expertise to ensure they align with your needs.
Review the 'Therapeutic Orientation' section to understand the methods that will be used during therapy. This will help you gauge if it suits your preferences.
Complete any required fields regarding fees, insurance, and session details as outlined in the document.
Finally, sign and date where indicated to acknowledge your understanding and acceptance of the terms presented.

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2017	4.4 Satisfied (22 Votes)

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What is PDS in counseling?

The professional disclosure statement (PDS) is a document that an LPC, LMFT, registered associate, or temporary practitioner provides to each client that provides information about the practitioner and their practice. You must update your PDS if there are changes and ensure it contains current, accurate information.

What is an example of a confidentiality statement for counselors?

I cannot and will not tell anyone else what you have told me, or even that you are in therapy with me without your prior permission. You can authorize me to share information with whomever you choose, and you may change your mind and revoke that permission at anytime.

What should be included in a disclosure?

A disclosure statement is a document used to provide important information in transactions, ensuring transparency and preventing misunderstandings. It helps businesses protect themselves from future liabilities and maintain trust in their dealings.

How do I write an effective disclosure statement?

As mandated by the SEC, disclosures include those related to a companys financial condition, operating results, and management compensation.

What is an example of a disclosure statement?

I hereby docHub 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 docHub working relationship have (has) received something of value from a commercial party related directly or indirectly to the subject of

counselor professional disclosure statement example

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What is a disclosure statement example?

An effective disclosure statement should do the following: Identify all relevant parties involved. Determine and state the purpose of the disclosure. Outline and provide the information that needs to be included in the disclosure. Be written using straightforward, non-technical, and easy-to-understand language.

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

Your therapists name, credentials, education/training. Your therapists license and state registration number and the type of license or registration. Your therapists area of speciality.

Professional disclosure statement counseling example 2026

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