HELPING ADOLESCENTS AND ADULTS WITH LIFE TRANSITIONS
AND EVERYDAY CHALLENGES
Confidentiality & Privacy Policies
Please complete and sign all forms below (Intake, Authorization to Release Information and
Limits of Confidentiality) and bring with you on your first session. Please note if you are having difficulty completing these forms we can work on them during your first visit.
AUTHORIZATION TO RELEASE INFORMATION
The law protects the relationship between a client and a psychotherapist, and information cannot be disclosed without written permission.
EXCEPTIONS INCLUDE:
Suspected child abuse or dependent adult or elder abuse, for which I am required by law to report this to the appropriate authorities immediately.
If a client is threatening serious bodily harm to another person/s, I must notify the police and inform the intended victim.
If a client intends to harm himself or herself, I will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, I will take further measures without their permission that are provided to me by law in order to ensure their safety.
FORMS