Christian Counseling Agreement
You must be 21 years of age or over in order to purchase a Christian Counseling session here at Soul Clinic. In order to be fully informed about the Christian counseling you will be receiving, please read through this following agreement, fill out the consent form, including today’s date, checkmark what applies to you, then sign your first and last name in the black box the bottom. This form must be signed and the intake form must be completed and returned before we are able to proceed with your session. ***(Note to couples: Each individual should fill out their own form.)
The goal of Christian counseling is to help an individual think biblically about their current struggles in the context of a confidential, caring environment. A Christian counselor relies on Scripture as the sole authority for the way in which we conduct ourselves. Guided by biblical principals, the Counselors role is to utilize guided questioning, empathetic support, problem-solving, reflection/reading assignments, encouragement, and prayer to provide wise, biblical and faithful counsel to those who are hurting and in need.
We also focus is on the person’s thought processes, and how it may be influenced by past events such that they cause problems in the present. We also address the root cause and core issues of current problems so that lasting change and personal growth may occur.
What Our Christian Counseling Sessions Provide:
Focus on present problems and situations
Specific situations or behaviors
Short term therapy (for a period of weeks and up to 6 months)
Action and behavior focused
Guidance, support, and education to help people identify and find their own solutions to current problems
All interactions which take place in the setting of therapy are considered confidential. This includes requests by telephone, all interactions with this counselor, any scheduling or appointment notes, all session content records, and any progress notes that I take during your sessions. I will not even verify that you are a client. You may choose to give me permission in writing to release any or specific information about you to any person or agency that you designate.
Limits to this Agreement
In some legal proceedings, a judge may issue a court order. This would require this counselor to testify in court.
If I learn of or believe that there is physical or sexual abuse or neglect of any person under 18 years of age, I must report this information to county child protection services.
If I learn of or believe that an elderly person or disabled person is being abused or neglected, I must file a report with the appropriate state agency that handles elder abuse.
If I learn of or believe that you are threatening serious harm to another person, I am obligated to report this. This can be in the form of telling the person who you have threatened, contacting the police or placing you into hospitalization.
If there is evidence that you are a danger to yourself and I believe that you are likely to kill yourself unless protective measures are taken, I may be obligated to seek hospitalization for you or to contact family members or others who can help provide protection.
There may be times when I consult with outside sources about cases. In these cases, no personally identifiable information will be used to discuss this case. However, discussion topics will be used in order to ensure that I am getting and giving the best assistance possible. The persons with whom I discuss cases are legally bound to keep the information confidential.
Your Rights As A Client
1. You are entitled to information about any procedures, methods of counseling, techniques and possible duration of therapy.
2. You have the right to end counseling at any time without any moral, legal or financial obligations other than those already accrued.
3. You have the right to expect confidentiality within the limits described.
4. You have the right to authorize your counselor to consult with another professional about your therapy in writing.
Contacting Soul Clinic Christian Counseling Services
To schedule an appointment, please email Natalie Parkerson at firstname.lastname@example.org
If you need to cancel or reschedule your appointment, please email Natalie Parkerson or call our office at 803-636-0250. If we’re unable to answer your call at that time, please leave a message and one of our staff associates will return your call shortly.
For emergencies after-hours, please call 911, or go to your local emergency room.
Before you make your purchase of a counseling session with Natalie Parkerson, you must acknowledge that you have read the aforementioned and agree to the terms by check-marking the boxes below and signing your first and last name in the black box below. Also, please fill out the attached contact form, which must include your first and last name, email address, phone number with any questions or concerns or the date and time you would like to schedule your session and we will email a reply to you at our earliest convenience.
I have read and discussed the above information. I understand the nature and limits of confidentiality.
Once You Have Completed, Signed and Submitted the Form Above, You May Now Purchase an Online Counseling Session and Schedule Your Appointment.
REFERRAL POLICY/DISCLAIMER After reviewing the intake form, we will determine whether or not we feel we can provide you with the appropriate services and level of care needed. Clients will be referred outside of The Soul Clinic Christian Counseling Center when treatment required is beyond the scope of care available here and if you’ve made a payment, you shall be promptly refunded.