I am committed to your privacy. Do not include confidential or private information regarding your condition on this form. This form is for general questions or messages. Please be aware that e-mail is not a secure means of communication and spam filters may prevent your e-mail from reaching me. If this is an emergency do not use this form. Call 911 or your nearest hospital.
The law protects the relationship between a client and a counselor, and information cannot be disclosed without written permission.
- Suspected child abuse or dependent adult or elder abuse, for which I am required by law to report this to the proper authorities immediately.
- If a client is threatening serious bodily harm to another person/s, I must inform the police and notify the intended victim.
- If a client intends to harm himself or herself, I will make every effort to enlist their cooperation in insuring their safety. If they do not cooperate, I will take further actions without their permission that are provided by law in order to ensure their safety.