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Welcome to the Heartfelt Counselor consent form.  This document outlines our online Christian Counseling policies, your rights and responsibilities, and our commitment to confidentiality.  Please review these terms carefully to ensure you understand our informed consent agreement before proceeding  with services.

Consent form

It is Dr. Davis policy to maintain an atmosphere that fosters compassion, dignity and the preservation of human rights while providing behavior-related services to persons.  The following are the client rights and responsibilities that uphold this policy.

 

RIGHTS

  • You have the right to Confidentiality of Information, which is governed by the Confidentiality Act.   All information regarding your treatment will not go beyond, unless written consent is given by you, if applicable, except by law.  If written permission is granted, you have the right to know what is contained in the information shared.

  • You have the right to respectful, considerate care. 

  • You have the right to receive services with adequate and human care in the least restrictive environment.

  • You have the right to every consideration of your privacy concerning your own care program.

  • You have the right to be free from abuse or neglect.

  • You will not be subjected to any type of punishment that violated your rights such as ridicule, humiliation, verbal abuse, or any other means of discipline.

  • You have the right to refuse service.

  • Treatment and/or services will not be denied, reduced, suspended, or terminated for exercising any of your rights.

  • You have the right to expect continuity of care, and to know, in advance, the times available.

  • You have the right to express your cultural practices and spiritual beliefs if they do not harm others or interfere with your treatment.

 

RESPONSIBILITIES

You are responsible for being an active participant in your treatment.  While we are here to support you in your goals, the motivation must be yours.

You are responsible for resolving conflict in a respectful manner, you must strive to solve the problem in a manner that is constructive.

If you need to cancel at anytime you will have 48 hours from the time of your appointment or we may impose a 

cancellations fee TBD.

 

Rates: TBD

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