Disclosure Agreement Just Mind

JUST MIND, LLC



Declaration of Practices and Procedures We are pleased that you have chosen Just Mind to fulfill your counseling needs This document gives you the answers to questions that people often have when entering a counseling relationship. Please discuss with me any questions or concerns you have about this information. Counseling Relationship We respect the uniqueness of each individual and this is a core of our beliefs. We work to help build an environment based on trust and warmth in which you may choose to examine and change patterns of behavior that may not be working for you. We would like this experience to be one which is reflective and where you learn about yourself through our time. We believe all clients have the capacity to change their own problems, but assistance helps. We would like you to try and reflect back on our sessions during the week to see you can get the most out of our sessions and help bring about the most change. The goal of the counseling relationship is that you choose new behaviors selected by you and that you implement them in your life. Qualifications and Area of Expertise Qualifications vary by provider. Please see our website or ask your provider about their background. All providers have a masters or doctorate in a mental health field. Their license’s range from LCSW, LPC, LMFT, to psychology. Each provider has different specialties as well. These things are specified in their profile on the website. If you would like to learn more, please ask you provider. Fees and Appointments We provide services on a sliding scale. These fees change depending on years of experience and provider availability. Fees currently range from $80 to $140 per hour. We are also available to you on the phone. If you chose to call us, the first 15 minutes are free. 15-30 minute phone consultations will be billed at the rate of one half of a session; 30-45 minutes at a full session rate. There is no charge for missed or cancelled appointments provided 24 hours notice is given. You will be charged for the full session if you do not cancel 24 hours in advance. Appointments missed due to inclement weather, in which it is dangerous to travel, are billed at one-third the agreed rate, which balances the loss of personal growth to you, and the loss of livelihood to be. It is possible to negotiate the availability of alternate times when circumstances change.

Code of Conduct We are required by Texas State law to adhere to the Code of Conduct for Licensed Professional Counselors, Licensed Clinical Social Workers, Licensed Marriage and Family Therapists, and Licensed Psychologists. These documents specify appropriate professional conduct for service providers. A copy of this document is available to you and will be provided free of charge upon request. The counselor will continue to monitor the progress of counseling and make recommendations as needed to other professionals. This may include recommendations to see a primary care physician or even another mental health professional for continued care. A complete physical examination is strongly suggested if you have not had one within the past 12 months. Furthermore, it is necessary for you to list all medications that you take.

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Privileged Communication The relationship between the counselor and the client is considered by law as confidential and will be held in strict confidence. All records kept by the counselor are confidential. Exceptions to privileged communication exist if it pertains to child abuse, injuring oneself, or intent to harm someone else. The law requires the counselor in these exceptions to inform the appropriate authorities. Emergencies In an emergency you may contact us at our office (512.843.7665). If we cannot be reached you may call the Crisis Cope Line (504.523.2673). Client Responsibilities The counseling process is a cooperative effort on the part of the client and the counselor. For the process to work, the client needs to be motivated to change and be responsible for his or her behavior and feelings. Clients are expected to be honest with the counselor and work toward resolving problems for which help was sought. Ultimately, the responsibility for setting and accomplishing any specific goal in counseling rests with the client. The client needs to recognize that meaningful change is never an easy task, and at times, could be difficult, painful, and threatening as well as rewarding. It is also important to recognize that as a result of the counseling process, the client may realize that additional issues exist which may not have surfaced prior to the onset of the counseling relationship. Accepting clients who are presently seeing another mental health professional (psychologist, board certified social worker, etc) is a violation of our Code of Conduct, unless the other professional relationship is terminated or permission has been granted by the therapist to work with the same client. If you wish to establish a counseling relationship with me and you are presently seeing another mental health professional, it will be necessary for you to terminate the other counseling relationship or allow us to contact the other therapist to seek permission for both of us to work with you. I have read and understand the above Declaration of Practices and Procedures.

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