Informed Consent for Assessment and Treatment

This document thoroughly describes the counseling process and other policies of Nate Marshall Counseling, PLLC. If submitting this form electronically, all fields must be completed. If you are printing this out and completing it by hand, you will need to write your name on the top of each page and initial the bottom of each page, which indicates that you have read the information contained on that page. In the middle of page 4, there is a spot that requires another initial, indicating that you have been given access to the HIPAA Notice of Privacy Practices Statement (available below). Towards the top of page 7, there are three sections to initial to ensure that you have reviewed these particular policies, as they are very important. Towards the bottom of page 7 your signature, printed name, and date are required. FInally, page 8 is an overview of the fee schedule for different services offered through Nate Marshall Counseling, PLLC. On the bottom of this page is the final place where you will need to sign, print your name and provide the date.

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Welcome

Thank you for contacting Nate Marshall Counseling, Professional Limited Liability Company (PLLC) for your therapeutic needs. In order to start our relationship in a healthy way, I have put together this document to ensure that you fully understand what to expect in our work together and that there are no misunderstandings about the various aspects of the counseling and psychotherapy services I offer. Even though this document is lengthy, I ask that you carefully read the entire 8 page document in order to ensure that you fully comprehend the policies and procedures of Nate Marshall Counseling, PLLC. The information that follows will acquaint you with all of my policies and procedures. I am always available to answer any questions you have regarding any of these policies.

I serve individuals over the age of 18 and do not discriminate or withhold services on any grounds: age, gender, ethnicity, sexual orientation, or religion.

The Counseling Process

The purpose of counseling is to assist you in meeting the goals you identify as important in your life. This may include decreasing target symptoms or emotions, learning new coping strategies, improving relationships with others, or gaining a better understanding of the events and situations in your life.

Counseling can, and usually does, involve the sharing of sensitive, personal and/or private information with your therapist. At times, this may result in increased anxiety or distress in your personal and professional life. While the outcome of counseling is generally positive, there is no way to predict the level of satisfaction you will achieve through this process. As part of this process, it is important that you openly and honestly provide any necessary information that can affect your progress. At times, your therapist may also ask you to complete “homework assignments”, or other activities outside the counseling session. Often, progress towards your goals can depend as much (or more) on what you do outside of sessions than in sessions. You may discontinue therapy at any time, but please discuss any desires or decisions to discontinue with your therapist.

Sessions will generally occur in the office, however, there may be times that we will hold our sessions out in the community for a variety of reasons including, but not limited to: client or therapist preference when mutually agreed, for the purpose of exposure therapy, or facility issues. Please understand that any meeting in the community will involve some risk to confidentiality. These issues will be thoroughly discussed if a meeting in the community is to happen.

The Therapeutic Relationship

The client/counselor relationship is unique in that it is exclusively therapeutic. In other words, it is inappropriate for a client and a counselor to spend time together socially, to bestow gifts, or to attend family or religious functions. The purpose of these boundaries is to ensure that you and I are clear in our roles for your treatment and that your confidentiality is maintained.

If the situation arises where we are in the same location outside of our session time (for example, see each other at the grocery store or any other public place), my policy is to allow you to initiate contact if you choose to do so. In order to protect your confidentiality, I will not approach, acknowledge or communicate with you in any fashion until you initiate contact. Furthermore, I will only engage with you in the manner you initiate (for example, if you nod your head to me, I will return the gesture; if you initiate a conversation and introduce me to others, I will engage in that exchange).

If there is ever a time when you believe that you have been treated unfairly or disrespectfully, in or out of sessions, please talk with me about it. It is never my intention to cause this to happen to my clients, but sometimes misunderstandings can inadvertently result in hurt feelings. I want to address any issues that might get in the way of the therapy as soon as possible. This includes administrative or financial issues as well.

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