Consent Form

Dear Client:

Before we start our work together, you should know that you have certain rights and responsibilities. In addition, as your counselor I also have rights and responsibilities.

1. You have the right to a free, no obligation, one time consultation with Mr. Lynn T. Austrheim, to ask questions and to discuss your challenges and goals.
   
2. Your counselor is a Licensed Clinical Social Worker and is not a physician/medical doctor, and does not practice medicine. If medical treatment or medicine is required your counselor will recommend that you see a physician. Your counselor takes no responsibility for services provided by other professionals.
   
3. Confidentiality is your right. Within legal limits, clinical information revealed by you to your counselor, will be kept strictly confidential. Even the fact that you are a client is confidential.
   
4. An exception to confidentiality is that your counselor is required by law to report any incidences of child or elder abuse or neglect to the proper authorities. In addition, the threat of bodily harm or death to another person will reported to the proper authorities and, if known, to the person threatened.
   
5. The Counseling Advantage and Mr. Lynn T. Austrheim do not warrant or imply the confidentiality of any information conducted by electronic means. If you require special security measures, discuss your requirements with your counselor.
   
6. You have the right to choose that certain therapeutic techniques not be used.
   
7. No audio or video recordings will be made of your sessions unless you grant permission in writing.
   
8. You have the right to end counseling at any time, without any moral, legal, or financial obligation, except for financial debt for past counseling. If you have more than two unexcused absences from your telephone or face-to-face consultation, it will be assumed that you have terminated your counseling.
   
9. If your counselor cannot be reached and you need help, it is your responsibility to seek another resource or to use the services of a hospital emergency facility.
   
10. Your counselor reserves the right to end counseling at any time without any explanation.
    

By clicking on the I AGREE button above, I confirm that I have read, or have had someone read to me, all of the above text, and that I fully understand all of the features, rights, and obligations I have as a client. I also state, as a client of counseling, that I willingly and freely agree to participate in the counseling program as described in this document.