Professional Individual Consultation
Informed Consent For Clinical Consultation (Consultant-Consultee Contract)
- I wish to receive clinical consultation from Stephen Terrell.
- I understand that these consultations do not constitute clinical supervision and that I remain completely responsible-ethically and legally - for the decisions I make in my own clinical case supervisions. Terrell will provide me with an opportunity to discuss clinical cases and issues about which he may have some clinical expertise, and he may help me consider options for responding, but the comments made for my consideration are not supervised mandates.
- I also understand that although we may sometimes need to discuss personal issues that may be relevant to my clinical work, these consultation services do not constitute psychotherapy.
- I understand the potential limits of the confidentiality of this relationship. To the extent possible, my case presentations will provide no identifiable patient information. However, I understand that if I provide identifiable information about a situation regarding which Terrell has an ethical or legal obligation to report confidential information, he will inform me at the time and will give me the opportunity to make the report myself.
- I understand that if Terrell becomes aware that he knows or has a prior relationship with the presented client(s), or if he believes he has a potential conflict of interest in his relationship with me, he will notify me of that fact immediately and will cooperate in helping me find a different consultant
- I prefer using Zoom.us because it is HIPPA compliant and protects your privacy as well as mine during the consultation. Be sure and download the free version for your use.
- My username on Zoom.us is email@example.com (786-353-9671)
- Please be sure to add me to yourZoom.us account prior to time of our appointment.
- I do my best to connect right on the hour. If I don’t, you are welcome to connect to me. Be sure you show online status or Zoom.us doesn’t allow connections.
- Consultations are 45 minutes in length.
- Consultation are $150.00 USD and are paid in full at time of scheduling or invoiced at the end of the session.
- This is your time, use it as you wish. Most find it useful to have lists about what they want to review during the session.
- Even though Terrell may jot down notes during consultations, all notes are destroyed at the end of the consultation and Terrell maintains no ongoing notes on cases/coaching presented.
- I look forward to connecting. If you need to cancel for any reason, please cancel a minimum of 24 hours CST to your session to prevent billing.
- By scheduling you agree to all the above conditions. If you don't agree for any reason, please contact me so we can talk about it before scheduling an appointment.