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Informed Consent

South Shore Counseling

Informed Consent for Counseling Services

Welcome to South Shore Counseling. This document contains important information about our professional services and business policies. Please read it carefully and let us know if you have any questions.

Confidentiality: All communications between you and your therapist will be held in strict confidence unless you provide written permission to release information. There are some exceptions to confidentiality required by law, including: suspected child or elder abuse, if you present a danger to yourself or others, or if a court orders the release of information.

Treatment Process: Counseling is a collaborative process. Your active participation is essential for success. Sessions are typically scheduled weekly at the beginning of treatment and may decrease in frequency as progress is made.

Appointment Policy: Sessions are 50 minutes long. Please provide at least 24 hours notice if you need to cancel or reschedule. Late cancellations or no-shows may be subject to fees.

Payment & Fees: Payment is due at the time of service. We accept cash and credit cards. If you are using insurance, please understand that you are responsible for any copays, deductibles, or non-covered services.

Emergency Procedures: If you are experiencing a mental health emergency, please call 911 or go to your nearest emergency room. You may also contact the National Suicide Prevention Lifeline at 988.

Consent Acknowledgments

Signatures

Client Signature

Client signature required

Guardian Information (if applicable)

N91W17194 Appleton Ave, Suite 204, Menomonee Falls, WI 53051

9735 W St. Martin's Rd, Franklin, WI 53132

P 414-502-7780 | W www.southshorecounseling.org