You have the right to considerate and
respectful treatment.
You have a right to every respect and
consideration of your privacy and individuality as it relates
to your social, religious, spiritual, economic, class, age,
mental, emotional, physical, cultural, racial, ethnic, gender,
sexual, sexual orientation and psychological well being.
You have a right to discuss your treatment
plan, estimated length of treatment and the possible costs
and benefits.
You have the right to be referred to
other services or professionals if I am unable to provide
a service that you need or want or that is useful to you.
You have a right to expect that I have
met the minimal qualifications of training and experience
as required by state law.
You have a right to reasonable responses
to your requests.
Client Responsibilities
To participate as honestly and openly
in the therapy process as you can.
To ask questions when you don’t
understand something.
To participate in treatment planning
and in following the treatment plan.
To discuss how the therapy is affecting
you, your life, work, and relationships.
To keep therapy appointments and to
call to cancel and reschedule if necessary.
To keep me informed of any change in
residence, telephone number, employment, finances, or insurance.
To end therapy in a way that helps you
realize and make use of what you have learned.
To pay your fee each session. You are
responsible for your bill in its entirety regardless of your
insurance coverage or payment.
Client Legal Rights
The Minnesota
Data Privacy Act and the Health
Insurance Portability and Accountability Act of 1996 require
that clients be informed of their rights concerning records.
The details will be covered in your first session, but generally
speaking:
You are free to refuse to give information that you prefer not to disclose.
You have the right to look at or obtain access to anything in your file.
Information I keep about you
may be shared with others only under the following circumstances:
You sign a consent for release of information.
In an effort to save your life or someone
else’s life.
If you are pregnant, I must report prenatal
exposure to controlled substances.
If I have knowledge that a therapist abused a client, I am required to report it to the appropriate regulating board.
If a court order or subpoena exists requiring release of information.
You have a right for your records to be protected from loss, destruction or misuse.
You will be fully informed before or
during your first session of fees for service.
You have a right to privacy as it relates
to your treatment. I do participate in a consultation group
and share information there to the extent necessary for me
to provide quality services to you.
You have a right to be free from exploitation for my benefit and advantage.
You have a right to discuss any complaints
you have about the services you receive from me. Please discuss
any complaints with me. If you are unable to resolve them
this way, you have the option of discussing your concerns
with anyone you choose, including other therapists.
You have the right to contact my licensing board:
The State of Minnesota Board
of
Social Work
2829 University Avenue SE, Suite 340
Minneapolis, Minnesota 55414
