Home
Forms Library
Professional disclosure statement counseling example

Personal disclosure statement counseling example 2026

professional disclosure statement counseling example Preview on Page 1

See details

4 out of 5

59 votes

The document is a Professional Disclosure Statement for John Doe, a Licensed Graduate Professional Counselor in Maryland. It outlines his qualifications, including education and clinical supervision details, and provides necessary information regarding the services he offers, as well as a fee schedule. This disclosure is mandated by the Maryland Board of Professional Counselors and Therapists to ensure transparency in counseling practices.

Here's how it works

01. Edit your professional disclosure statement counseling example online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send professional disclosure statement counseling template via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out personal disclosure statement counseling example with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the personal disclosure statement in the editor.
Begin by entering your name and credentials at the top of the form. Ensure that you include your degree, program of study, and university name.
Fill in your contact information, including the counseling agency/practice name, street address, city, state, zip code, phone number, fax number, and email address.
In the section regarding clinical supervision, provide the supervisor's name and credentials. Include their license number and any applicable details about their practice.
Complete the fee schedule section by listing your services along with their corresponding rates. This is essential for transparency with clients.
Review all entered information for accuracy before saving or exporting your completed document.

Start using our platform today to effortlessly complete your personal disclosure statement for free!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

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 is an example of a personal statement for counselling?

With a strong educational background and extensive experience in counselling, I believe I am an ideal candidate to embark on a Masters in Counselling, practice route. I am a mature and responsible individual with strong communication skills who has a long standing and successful career in counselling.

How to write a personal statement for counselling?

Examples: Explain clearly why you want to study counselling, psychotherapy, and occupational therapy, and explain what you know already about the subject. Give examples of articles youve read, programmes youve watched, or podcasts youve listened to that have given you further insight.

What is an example of a self-disclosure statement?

I believe that my formal qualifications, together with my own personal experience, makes me an ideal candidate for the above position. Very many thanks for giving me the opportunity to discuss my convictions at interview and I look forward to hearing from you in due course.

What is a good example of a personal statement?

After completing my degree, my goal is to work as a mental health counselor in an academic or community setting. An area of clinical focus that I find myself drawn to, in addition to how best to support survivors of abuse and/or assault, is mental health treatment and intervention in a community setting.

personal disclosure statement counseling example

Professional Disclosure Statement counseling example pdf Professional Disclosure Statement counseling student Professional Disclosure Statement School Counseling example Personal Disclosure Statement example Professional Disclosure Statement examples Professional disclosure statement counseling intern LCMHCA Professional Disclosure Statement example Professional Disclosure Statement counseling Michigan example

Security and compliance

At DocHub, your data security is our priority. We follow HIPAA, SOC2, GDPR, and other standards, so you can work on your documents with confidence.

Learn more

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