Professional Agreement

Please read the following carefully. It is your responsibility to understand the conditions of establishing a counseling agreement prior to entering into the counseling relationship. Continuing into the counseling relationship is considered your acceptance and understanding of these terms. Should you have any questions concerning this agreement, please call or e-mail my office.

Phone: 734 337 2023
Email: cwilson@connectionprinciple.com

   Confidentiality
    Visits for counseling services are confidential. Information shared with the counselor is released for the following reasons:
   1. Legal requirements necessitate the counselor to report: abuse or neglect of minors, abuse,      neglect or exploitation of elderly or disabled persons.
   2. If a threat exists for immediate harm to the client or others, appropriate medical or law enforcement agencies will be contacted by the counselor.
   3. Clients who are in a crisis or emergency situation are instructed to call 911.
   4. Legal issues involving the client that results in demand for information as per a court order.
   5. With the client's written consent.

    Confidentiality for Couples Counseling
If individual counseling sessions are indicated, the counselor will maintain confidentiality with each partner unless it is believed that the information given is detrimental to the progress of the couple in therapy. If the counselor is given information by one partner (including phone calls, or email communication) that appears to be an impediment to progress of the couple in therapy, the counselor will encourage and support the partner with the undisclosed information to share the information in a conjoint session. The counselor will not share this specific information without the partners consent, but if the partner refuses to share the information in a conjoint session, referral to another therapist is indicated. If information given in an individual session indicates that treatment outside my professional expertise is needed I will provide appropriate referrals.
   Counseling purposes, goals, and risks
The practice of counseling by licensed professional counselors is for the purpose of utilizing interpersonal, cognitive, cognitive-behavioral, behavioral, psycho-dynamic, and affective methods and strategies to achieve mental, emotional, physical, and social development and adjustment throughout the life span. Risks of counseling may include possible changes in the relationship of married couples, as a consequence. A professional counselor will always strive to provide quality care for each client, and support clients in reaching resolution to the issues at hand.
   Evaluation for Services
Prior to setting an appointment, each client must provide as much information as possible, so counselor may briefly evaluate clients needs. This can be done by telephone or e-mail. The purpose is to establish the client's needs and appropriate mode of services. There is no charge for this exchange of information.
   Fee Agreement
Fees paid by credit card, will be collected prior to services provided. Credit card payments must be made utilizing the Online Payment option in this web site.

    My hourly rate per client hour is no more than $125.00. Fees are flexible and arranged with client prior to provision of services. Fees for court appearance or deposition, if required, shall be no more than $50.00 per hour, payable by the client. In the event that a client's records are ordered released by subpoena, a charge of $30.00 shall be assessed to the client.
   Insurance Provider
The client is asked to self-pay and file with his/her insurance company for reimbursement. Responsibility for payment rests with the client.
   Missed or Canceled Appointments
Client agrees to cancel appointments at least 24 hours in advance. Clients not giving proper cancellation notice will be charged a $50.00 fee for each missed appointment or $25 to reschedule..
   Fee Refunds
Refunds will be given for the following reasons:
Client gives at least 24 hours notice to cancel prepaid appointment.
Counselor fails to keep the appointment.
    Due to the security of the credit card payment program, counselor cannot access your card information for a refund to your card.
    If for any reason you are dissatisfied with the services provided and wish to receive a refund, please call my office. Phone: 734 337 2023. All refunds will be made by check and mailed to the client within seven days.
   Referrals for Additional Services
Occasionally the client may need additional services not offered by the counselor. Counselor will provide client with referrals if possible. However, client holds the responsibility and risk for contacting and accepting these services and their outcomes.

Scheduling Appointments
Please call 734 337 2023, or contact me at cwilson@connectionprinciple.com, for a brief evaluation of your counseling needs and to discuss fees. Appointments are available at convenient times. If unable to keep an appointment, notification by phone 24 hours before the scheduled time is required. You will be charged $50 for any missed appointments without 24 hour notice.
By making arrangements to use the counselor's services, you are agreeing to all conditions stated in this policy. To continue to the Online Payment Page click here.

Termination of Services
Client or counselor may choose to terminate the counseling relationship at any time. The party choosing to terminate the relationship agrees to contact the other party through e-mail or written letter, with reasons for termination. Client may choose to terminate the counseling relationship at anytime. Counselor may terminate relationship if they feel the client has reached their goals, the client is not progressing under the counselors care, or the counselor is not qualified to provide the services needed at this time. Counselor agrees to provide the client with referrals for more appropriate services should this be needed.