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Privacy Clause

I am bound by a professional cod e of ethics to maintain and support client’s rights in terms of communication received regarding treatment services (both in and out of formal sessions).  All areas discussed in therapy will remain strictly confidential .  By law, health care information may only be released with a formal written consent by the person receiving services (and if a minor, by parent or guardian).  In the event release of information is desired, an “Authorization for the Disclosure and Reciprocal Exchange of Information” form must be completed. 


When provision of services is initiated, I will establish a file that contains all information provided by you, as well as my own documentation, and all documents in the file will remain confidential.  You may have the right to review your file with me if you choose.  Should I need to obtain or share information with other professionals about you for treatment purposes, I will discuss this with you and will ask for your written permission/consent to do so.  The following are exceptions to full confidentiality:

  • If disclosure is necessary to prevent clear and imminent danger to yourself or another.  This includes verbal intentions you may make to seriously harm yourself or another person.

  • If I am ordered by a judge to release information, then I must release information and will only release the minimal amount of information required in order to protect your privacy.

  • If you are using an insurance company to pay for services, a diagnosis will be submitted in order for me to be reimbursed.  At times, additional records are requested.  I will only release the minimal amount in order to protect your privacy.

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