Kelly Harrison, MACC, LPCA, LMFTA 505 Oberlin Road, Suite 110 Raleigh, NC 27605 9192723139 Client Disclosure Statement (Information and Consent for Treatment) I am pleased that you have chosen me for your counselor 2025

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  1. Click ‘Get Form’ to open the Client Disclosure Statement in the editor.
  2. Begin by reviewing the qualifications section. This provides insight into my background and training, ensuring you feel confident in your choice of counselor.
  3. Next, navigate to the Counseling Services Offered section. Here, you can understand the various areas I specialize in and how we can work together towards your goals.
  4. Fill out the Confidentiality section carefully. It outlines how your information will be handled and under what circumstances confidentiality may be breached.
  5. Complete the final section by signing both copies of the form. Ensure you provide your signature and date where indicated to confirm your understanding and consent.

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